MDI Hospital Job Shadow Program Application

MDI Hospital Job Shadow Program Application

The MDI Hospital Organization Job Shadow program allows participants the opportunity to experience the workplace setting as well as the duties performed by the health care workers, they are shadowing; however, they will not be permitted to take part in hands-on patient care.

Job Shadow candidates must be a minimum of 16 years of age. Each job shadow experience will be scheduled for 4-8 hours* on an individual basis. Requests are subject to department manager approval and may be limited due to staff availability or workload. Every attempt will be made to accommodate your learning needs, however; there may be times a request for a job shadow experience is declined.

Please be advised, shadow opportunities are currently not available in the Emergency Department.

Last Name*

Please enter your last name.

First Name*

Please enter your first name.

Date of Birth*

Please enter your Date of Birth.

Phone Number*

Please enter the best phone number to reach you.

Phone

E-Mail Address*

Please enter your e-mail address.

Address - Street Address*

Please enter your street address (e.g., 123 Main Street).

Address - City*

Please enter your city.

Address - State*

Please enter your state.

Address - ZIP Code*

Please enter your ZIP Code.

Are you currently attending school?*

Yes

School Name / Grade Level

Job Shadow Interests

Please select up to three of your top interests for job shadowing.

1st Interest*

Select

2nd Interest

Select

3rd Interest

Select

Interests / Goals*

Please describe your interests and goals for this job shadow experience in the space provided below:

Attachments

Recommendation Letter*

You may upload your recommendation letter here. If you are unable to do so, please E-Mail a letter of recommendation from a school advisor or mentor to Molly.Moon@mdihospital.org.

Drag and drop files here or

Send me a copy of my responses

Privacy Notice|Report Abuse