Updated information on COVID-19 and Flu: Restricted visitation is now in effect
Job Shadow Application for Adults

We regret to announce Sparrow's Job Shadow program for Adults and Minors is temporarily suspended, however, we will continue to receive applications. Sorry for any inconvenience this may have caused. Thank you.
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Last Name:
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First Name:
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Street Address:
Apartment:
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City:
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State:
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Zip Code:
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Phone Number:

Format: (xxx) xxx-xxxx

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Email Address:
Location Requested:



Additional Information

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Highest level of education completed:
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Name of School:
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Career Interest:
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Have you volunteered at Sparrow within the last 12 months?

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Please write a sentence or two as to why you would like to job shadow:
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I am interested in the Job Shadow Program because:



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Are you a Sparrow employee?:

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Have you ever been terminated from Sparrow Health System?

Emergency Contact Informaton

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Last Name:
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First Name:
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Street Address:
Apartment:
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City:
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State:
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Zip Code:
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Phone Number:

Format: (xxx) xxx-xxxx

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Relationship:

I have read and agree to the following:

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1. I will attend the required orientation with Human Resources and will complete the orientation within 1 year of orientation (TB skin test expires after 12 months). Orientation for Sparrow Clinton and Sparrow Ionia sites will be scheduled by HR following receipt of your application.

2. I will uphold all Sparrow Health System's policies, procedures, and protocols.
 
3.  I expect no remuneration for this education experience.
 
4.  I will participate ONLY as an observer and, will NOT participate in any hands-on activities involving the patient.

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Name:
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Date:

mm/dd/yyyy format: