Job Shadow Approval Form (Step 1) and Instructions

Do you wish to add your information to this form prior to downloading? Do you wish to pre-fill some of your information?*

YesNo

Pre-Fill applicant name (OPTIONAL).

First NameLast Name
Pre-Fill applicant phone number (OPTIONAL).
Please enter a valid phone number.Format: (000) 000-0000.
Pre-Fill applicant email (OPTIONAL).
example@example.com
Pre-Fill sponsor name & title (OPTIONAL).
Full Name
Pre-Fill sponsor email (OPTIONAL).
example@example.com
Pre-Fill department in which job shadow will occur (OPTIONAL).
Pre-Fill proposed job shadow date. (Please allow 2-3 weeks for processing.) (OPTIONAL)

MonthDayYear
Date
Pre-Fill proposed job shadow time (OPTIONAL).

Hour Minutes

AM/PM Option
Pre-Fill proposed job shadow location (OPTIONAL).
I have reviewed the above information and have met the requirements listed above. I have provided documentation of required immunizations to my sponsor. Further, I agree to hold harmless Skagit Regional Health from any present and future liability and/or damages for injuries arising from or growing out of this job shadowing experience.
Date

MonthDayYear
Date

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