Job Shadow/Internship/Externship Application

Job Shadow/Internship/Externship Application

Please fill out this application in its entirety. Once submitted, someone will reach out to you shortly to schedule an interview. Due to the high volume of requests, we may not be able to accommodate your desired program requirements in a timely manner
Personal Information:
Full Name*

First NameMiddle NameLast Name
Preferred Pronouns
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number*

Area CodePhone Number
E-mail*
Shadow/Internship/Externship Position Details:
Position Applying For*
Date You Can Start*

MonthDayYear
Have You Applied Here Before?*

YesNo
Total Hours Required/Requested*
Date You Need Your Hours Completed By*

MonthDayYear
Date
Availability*
Please list the days and times you are available
Coordinator Contact

First NameLast Name
Coordinator Phone Number

Area CodePhone Number
Coordinator Email
example@example.com
Does Your Program Allow a Paid Internship/Externship?

YesNoUnsure
Additional Program Documentation and Requirements

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Personal and Professional Goals and Objectives*
Please list any personal or professions goals and/or objectives you wish to accomplish during your time spent at SHPH
Education:
High School*
Name of High School Attended
Number of Years Attended*
Graduated?

Yes
College or Trade School
Name of College/University/Trade School Attended
Number of Years Attended
Graduated?

Yes
Area of Study/Degree
Other College or Graduate School
Name of College/University/Graduate School Attended
Number of Years Attended
Graduated?

Yes
Area of Study/Degree
Any Additional School/College Attended
Name of Any Additional School/College Attended
Number of Years Attended
Graduated?

Yes
Area of Study/Degree
Skills/Qualifications/Interests:
Skills
List any relevant skills
Qualifications
List any relevant certifications or qualifications
Interests
List any special areas of interest
References:
Reference 1*
Name of Reference
Relationship*
Years Acquainted*
Phone*
Email*
Reference 2
Name of Reference
Relationship
Years Acquainted
Phone
Email
Reference 3
Name of Reference
Relationship
Years Acquainted
Phone
Email
Cover Letter & Resume:
Cover Letter

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Resume

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References

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Send Application:
By clicking the submit button below, I cerity that all of the information provided by me on this application is true and complete, and I understand that if any false information, ommissions, or misrepresentations are discovered, my application may be rejected and, if I am enrolled, my shadow/internship/externship program may be terminated at any time.

In consideration of my application, I agree to conform to the company's rules and regulations, and I agree that my enrollment and applicable compenstation can be terminated, with or without cause, and with or without notice, at any time, at either my or the company's option.

I also understand and agree that the terms and conditions of my shadow/internship/externship may be changed, with or without cause, and with or without notice, at any time by the company.
Should be Empty:

Job Shadow/Internship/Externship Application

Personal Information:

Shadow/Internship/Externship Position Details:

Education:

Skills/Qualifications/Interests:

References:

Cover Letter & Resume:

Send Application: