LNA Summer Nurse Internship Application Form - D-H Workforce Readiness Institute

Name *

First

Last *

Last

Email *

Phone *

Address *

Address Line 2

City *

State *

Zip *

Do you already have your NH Nursing Assistant License? *

Yes

No

What is your license number? *

If you are planning on relocating for the summer internship program, are you interested in receiving resources on finding housing in the area? Please note, D-H is unable to provide housing for interns. *

Yes

No

What areas of nursing are you most interested in? *

Medical/Surgical

Critical Care

Women’s & Children

Ambulatory

Questionnaire:

To help us better know you and further assess your qualifications for this position, please answer the following questions as accurately as possible.

Have you previously been employed by Dartmouth-Hitchcock at any of its locations? If yes, please indicate location and department. *

Yes

No

Location and Department *

Are you a current employee of Dartmouth-Hitchcock? If yes, please indicate location, department and date of hire. *

Yes

No

Location and Department *

Have you applied for a Workforce Readiness Institute Program before? *

Yes

No

Which program have you applied for/participated in? *

Are you legally eligible for employment in the United States? *

Yes

No

Will you now or in the future require sponsorship for employment visa status (e.g. H-1B visa status)? *

Yes

No

Are you under 18 years of age? *

Yes

No

Have you ever been convicted of any felony in any state (regardless of type of offense); or any misdemeanor offense of sexual assault, other violent crime, assault, fraud, theft, abuse, neglect or exploitation of any person, that has not been annulled by a court? (Note to Applicant: Convictions which have not been annulled will not necessarily bar you from employment. We will consider factors such as age when the offense occurred, the recentness of the offense, the seriousness and nature of the violation, the nature of the position applied for and any rehabilitation undergone. Failure to disclose a conviction can lead to withdrawal of the employment offer.) *

Yes

No

How did you hear about the program ? How did you hear about the program ?

Please let us know if there is anything you'd like to add about your experience as an LNA.

Please upload the following documents:

Current resume
Cover letter describing your interest
Professional letter of recommendation

If you are missing documents at the time of your submission, please e-mail them to wri@hitchcock.org with the subject line of “LNA Nurse Internship Application"

Upload your files here. Multiple files accepted. Please only upload the following file types: .doc .docx .pdf

Maximum file size: 52.43MB