Spring 2022 Church Health Intern Application Form

Fall 2023 Church Health Internship Application

**Please note this application is ONLY for those wishing to serve starting in August 2023**
CONTACT INFORMATION
Name*

First NameLast Name
Email:*
Phone Number:*
Birthday*

MonthDayYear
Gender*
EDUCATION

Please give the information for the school you currently attend. If you are not in school, please list the infortmation for the school of the higest degree/certificate you have received.
Name of School:*
City and State:*
Major*
Current Classification:*
Degree:*
Graduation year or anticipated graduation year:*
Are you applying for academic credit for this internship?*
If yes, who is your supervisor? Please include title and contact information:
Please note: Church Health does not have any clinical or preceptor opportunites for graduate students.
OCCUPATIONAL HISTORY

Please describe your previous work experience (paid and volunteer) beginning with the most recent. Failure to provide a work history at all will be considered an incomplete application and will not be considered.
EMPLOYER AND LOCATION:*
DATE STARTED:*
DATE ENDED:*
RESPONSIBILITIES:*
EMPLOYER AND LOCATION:*
DATE STARTED:*
DATE ENDED:*
RESPONSIBILITIES:*
REFERENCES

Please provide two professional or academic references. These should not be family members or friends.
NAME OF REFERENCE:*
RELATIONSHIP TO YOU:*
PHONE:*
EMAIL:*
NAME OF REFERENCE:*
RELATIONSHIP TO YOU:*
PHONE:*
EMAIL:*
SHORT ANSWER QUESTIONS

Please be thorough in your answers and use correct punctuation and grammar. Applications without complete answers will not be considered.
What particular skills, talents or gifts do you have that would be an asset to Church Health? Please include any foreign languages (and your proficiency level).*
What are your short and long-term goals? How will an internship at Church Health help you to achieve these goals? *
Please describe any work or volunteer experiences you have had and describe the impact these activities have had on your life so far.*
AVAILABLE POSITIONS

Please review the internship descriptions on our website for more information on each of these opportunities
With which department would you like to intern? First Choice:*

Business (MEMPHIS Plan)The Well (Child Life*)DentalHealthcare AdministrationNutritionOptometry / Eye ClinicCommunications
Second Choice:*

Business (MEMPHIS Plan)The Well (Child Life*)DentalHealthcare AdministrationNutritionOptometry / Eye ClinicCommunications
*The Child Life Internship requires previous experience with children. If you are interested in the Child Life internship, please list your experience in childcare, education, or other relevant information.
How did you hear about the Church Health internship program?
Please indicate if you would want to be considered for others areas if you are not selected in your preferred work area.*

Yes, please consider me for other areas.No, I am only interested in the areas selected above.
INTERNSHIP COMMITMENT

Church Health requires interns commit to working at least 10-12 weeks and for no less than 8-10 hours per week (12 hours per week for child life). During the COVID-19 outbreak, interns are required to serve at least one shift in the CH Welcome Center assisting in screening for COVID-19. This maybe in addition to your 8-10 hours per week or included in that time, as determined by your supervisor.
All staff, volunteers and interns of Church Health are required to be full vaccinated against COVID-19. You will be required to provide proof of vaccination once you are accepted to a position. Are you vaccinated against COVID-19?

I am fully vaccinated against COVID-19.I am not vaccinated again COVID-19.
I understand that I am applying to be considered for an internship that will take place between August 2023 and December 2023.

I understand.This is not the time frame I am interested in.
Church Health is open during business hours, Monday - Friday. If you do not have any availability on weekdays from 8am-5pm, please do not submit this application. Child Life/ The Well does offer evening and weekend hours. What days and times do you anticipate being able to work at Church Health?*
ADDITIONAL DOCUMENTS
Please attach your current resume or other supporting documents you would like the intern coordinator to review.
Attachment(s)*

Select File

Cancelof
I hereby authorize Church Health and/or its agents to conduct such investigation of my intern application as considered necessary. I authorize any and all former employees and/or business references to furnish information concerning my past job performance, work and educational histories. I release any liability the above named individuals furnishing such information. I recognize a photocopy of this authorization is a valid requisition. I understand that any false statements on my application are grounds for dismissal or withdrawal of any offer of employment.
ELECTRONIC SIGNATURE:*
DATE:*
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Fall 2023 Church Health Internship Application