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    Fairview Nursing Student Internship Application
All applications must be received by December 6, 2013.
Selected candidates will be notified via email and interviewed between the end of December 2013 and January 2014.

If you are mailing any of the required documents, please mark all with your Application Number:

  Contact Information
  First Name * Middle Name Last Name *
 

School Address *
School City/ST/Zip *      

Permanent Address *
Permanent City/ST/Zip *      
Home Phone  -   - 
Cell Phone  -   - 
Email *
Email Verify *
  Note: Email will be used for all notification regarding your application.
  Educational Information
Academic Institution *
Date spring semester ends *   
Current GPA *
Expected graduation date *   
Additional Degrees
  Employment Information
Are you currently a Fairview
employee *
 Yes  No
If yes, provide: Facility
Department
Job Title
Are you in any educational
program sponsored by
Fairview or other health care
organization *    
 Yes  No
If yes, please explain.
Are you U.S. citizen *  Yes  No
If no, can you provide
evidence of a legal
right to work in the U.S.?
 Yes  No
Have you ever been convicted
or plead guilty to a misdemeanor,
a petty misdemeanor or a
felony? *
 Yes  No
  Scheduling Information
Would you need special
scheduling or time off during
the 10 week internship
program? *
 Yes  No
If yes, please explain.
  Preferences
Check all the hospitals you are interested in.
  Fairview Ridges Hospital, Burnsville, Minnesota
  Fairview Southdale Hospital, Edina, Minnesota
  University of Minnesota Medical Center, Fairview and University of Minnesota Amplatz Children’s Hospital, Minneapolis, Minnesota

List your top three (3) areas of interest. (Note: this will be taken into account for your assignment, but
it is not a guarantee of particular placement.)
1. 
2. 
3. 
  References
I have requested recommendations from the following individuals. Attach or provide contact information.
1. Name  
Title  
Address  
City/ST/Zip       
Phone   -   - 
Email  

2. Name  
Title  
Address  
City/ST/Zip       
Phone   -   - 
Email  
  Essay
Please answer one (1) of the following questions. Enter or attach your essay.
To be eligible, your essay must:
  - Be 300 to 500 words in length
  - Attached must be in word processed format
  - If attached, please have document double spaced
  - If attached include your name on each page

  You are nearing retirement - looking back over your life, what nursing accomplishments
are you most proud of, and what would you like to change?

     

  Reflect upon your experiences with nursing so far. How has your life or views changed?
     

  Resume
Please attach your current resume (containing information about your education, expected date of graduation, employment, community service/volunteer experience, awards and recognitions, and leadership.
 
 
  Transcripts
Please attach copies of transcripts (to date). If you do not have an electronic copy to attach, record application number on envelope and documents and please mail to:
Fairview Health Services
Summer Nursing Student Internship Program
Talent Acquisition
Attention: Bill Johnson, RN
2344 Energy Park Drive
St. Paul, MN 55108

Application Number