Central Office Volunteer, Unpaid Intern and Extern Interest Form

Volunteer, Unpaid Intern and Extern Interest Form
Thank you for your interest in becoming a volunteer, unpaid intern or extern for NYC Health + Hospitals. Please fill out the following form and a representative from Human Resources Workforce Development will contact you. Should you have any questions or concerns, feel free to contact us at CentralOfficeVolunteers@nychhc.org.
INFORMATION
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email *
example@example.com
Phone number *
Date of Birth*

MonthDayYear
Date
If you are applying for a specific internship opportunity, enter title of post here (type N/A is not applicable)*
Enter name of school or organization you attend (type N/A is not applicable)*
Major ( type N/A is not applicable)*
Have you ever worked, volunteered or been a student at NYC Health + Hospitals? *
Enter name of the location (type N/A is not applicable)*
Enter name of the department (type N/A is not applicable)*
Enter name of the supervisor (type N/A is not applicable)*
How did you hear about NYC Health + Hospitals?*
Why are you interested in becoming an intern or volunteer for NYC Health + Hospitals?*
What are your special skills and interest?*
Which department, facility or area would you like to engage in? (If you are interested in one of our job postings, please specify below.)*
Highest level of education*
Do you speak multiple languages?*
What language(s) do you speak? (You may choose more than one)*
Which days are you available? (You can select more than one)*

MondayTuesdayWednesdayThursdayFridaySaturdaySunday
Number of hours available per week*
Are you able to work in-person?*

YesNo
Are you a Service Veteran?*

What date are you available to begin, if appointed?*

MonthDayYear
Date
Click the button below to upload your resume*

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Click the button below to upload your cover letter

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Click the button below to upload your up to 4 examples of your work

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I understand and agree that submitting this application form does not automatically guarantee a position at NYC Health + Hospitals. I am aware there may be qualifications I must meet, including orientation, medical clearance, drug test and background investigation. By submitting this form, I attest that the information I have provided on the form is true, accurate, and NOT provided by a third party. In furtherance of the background investigation, I consent to and authorize the disclosure of all information NYC Health + Hospitals deems relevant to the evaluation of my eligibility to hold a position of public trust. I, therefore, authorize the disclosure of such information to NYC Health + Hospitals, including but not limited to, files and records maintained by former and current employers, hospitals, clinics and the U.S. Veterans Administration, by educational institutions, governmental bodies, professional associations, and by investigative, disciplinary, judicial or grievance bodies. Furthermore, as may be required under the Privacy Act of 1974, 5 United States Code Section 552a, and the Freedom of Information Act, 5 United States Code Section 552, I hereby give my consent to inquiries concerning me by NYC Health + Hospitals to any Federal agency or public or private entity, and to the disclosure to NYC Health + Hospitals by such Federal agency or public or private entity of any information the agency or entity may have pertaining to me, with the exception of any material which is specifically exempt from disclosure by a Federal statute other than the Privacy Act of 1974 or the Freedom of Information Act. I waive any privilege of confidentiality with respect to the release of any such information to the NYC Health + Hospitals. A photocopy of this authorization shall be considered effective and valid, as the original, which shall remain on file at the facility/business unit of the NYC Health + Hospitals, for this and any future reports or updates that may be requested. Further information may be made available upon written request within a reasonable period of time. To continue this form, click "I agree" at the bottom of this form.*

I agree
I understand and agree that submitting this application form does not automatically guarantee a position at NYC Health + Hospitals. I am aware there may be qualifications I must meet, including orientation, medical clearance, drug test and background investigation. By submitting this form, I attest that the information I have provided on the form is true, accurate, and NOT provided by a third party. In furtherance of the background investigation, I consent to and authorize the disclosure of all information NYC Health + Hospitals deems relevant to the evaluation of my eligibility to hold a position of public trust. I, therefore, authorize the disclosure of such information to NYC Health + Hospitals, including but not limited to, files and records maintained by former and current employers, hospitals, clinics and the U.S. Veterans Administration, by educational institutions, governmental bodies, professional associations, and by investigative, disciplinary, judicial or grievance bodies. Furthermore, as may be required under the Privacy Act of 1974, 5 United States Code Section 552a, and the Freedom of Information Act, 5 United States Code Section 552, I hereby give my consent to inquiries concerning me by NYC Health + Hospitals to any Federal agency or public or private entity, and to the disclosure to NYC Health + Hospitals by such Federal agency or public or private entity of any information the agency or entity may have pertaining to me, with the exception of any material which is specifically exempt from disclosure by a Federal statute other than the Privacy Act of 1974 or the Freedom of Information Act. I waive any privilege of confidentiality with respect to the release of any such information to the NYC Health + Hospitals. A photocopy of this authorization shall be considered effective and valid, as the original, which shall remain on file at the facility/business unit of the NYC Health + Hospitals, for this and any future reports or updates that may be requested. Further information may be made available upon written request within a reasonable period of time. To continue this form, click "I agree" at the bottom of this form.*

I agree
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