Professional Documents
Culture Documents
INFORMATION PACKET
AND APPLICATION
Classification for Fall 2015 must be a college sophomore, junior or senior or Spring 2015 graduate
Must have an academic record of a 2.80 g.p.a. or better on a 4.0 scale
Must show a sincere interest in and/or commitment to a career in health care
Must be authorized to work in the U.S.A.
Application Instructions:
Students must complete the attached application by typing or printing legibly. If you need more space, please use
additional sheets and identify each answer using the corresponding letters on the application. A resume or curriculum
vitae is not an acceptable alternative to a complete application.
Please refer to the enclosed checklist to ensure that your application is complete.
Submit your application to:
BHC 2015 Summer Internship Program
Human Resources, Room A-120
Bellevue Hospital Center
462 First Ave
New York, NY 10016
All applications must be postmarked by March 13, 2015 or hand delivered to Bellevue Hospital Human Resources
Department, room A-120 by Friday, March 13, 2015 5:00pm.
I.
PERSONAL INFORMATION
LAST NAME:
FIRST NAME:
MIDDLE NAME:
City:
State:
Zip Code:
Phone #:
Alternate
Phone #:
Email:
State:
Zip Code:
Present Address:
____ Present
Title: ____________________
Facility: ______________________
Name:____________________
Title: ____________________
Facility: ______________________
Name:____________________
Title: ____________________
Facility: ______________________
ACADEMIC INFORMATION
In addition to completing the information below, you are required to submit proof of enrollment in your undergraduate
school program (official letter from the schools registrar indicating enrollment status) as well as all official transcripts
from all schools attended.
I am classified as a (please check one):
____ Full-time undergraduate student
____ Part-time undergraduate student
Undergraduate Information:
Name of Academic Institution:
City:
State:
Zip Code:
Major:
Grade Point Average (cumulative):
Dates of Attendance
FROM:
Term Dates:
Classes END for Spring 2015:
Date of Graduation:
TO:
Classes BEGIN for Fall 2015:
III.
IV.
PERSONAL STATEMENT
On a separate sheet of paper, please prepare a personal statement, maximum 750 words, stating the following:
Interest in health care/ health care operations/ Public health
Career goals
Three major objectives for your internship
V.
RESUME
Attach a copy of your current resume.
RECOMMENDATIONS
Choose at least two (2) people as references who are knowledgeable about your abilities and performance. Select
at least one faculty member, one supervisor, or one volunteer community service supervisor. Recommendations are
not limited to these individuals. Personal recommendations from family members or friends will not be accepted.
Print your name on the reference form included in this application packet and send one to each of your references.
The reference forms may be copied. To ensure prompt processing of your application, please follow up with your
references to be certain they return the completed forms to you before the application deadline.
ONLY COMPLETE APPLICATIONS WILL BE REVIEWED. THERE ARE NO EXCEPTIONS!
I certify that the information given herein is true and complete to the best of my knowledge. I authorize verification
of all information in this application as it relates to the selection process.
Signature ________________________________________
Date ___________________
HOW DID YOU HEAR ABOUT BELLEVUE HOSPITALS SUMMER COLLEGE INTERNSHIP PROGRAM?
____ Friend
____ Employee of HHC/ Bellevue
____ Other
____ Parent
____ Website
APPLICANTS NAME:
EVALUATORS NAME:
EVALUATORS TITLE:
SCHOOL/ AGENCY:
STREET:
CITY:
PHONE:
EMAIL:
SIGNATURE:
DATE:
CATEGORIES
Leadership skills
Critical Thinking Ability
Motivation
Oral Expression
Empathy and Ability to work with Others
Self-confidence
Maturity
Reliability and Responsibility
Breadth of intellectual interest
RATING SCALE
SUPERIOR ABOVE AVERAGE
STATE:
AVERAGE
POOR
N/A
2. Please give an overall recommendation of the student for the Bellevue Summer Internship Program.
Highest recommendation
Strongly Recommend
Recommend as Satisfactory
Not Suitable at this time
Not Recommended
Insufficient Evidence to Evaluate
3. If you would like to share additional comments, please use the space provided below.
APPLICANTS NAME:
EVALUATORS NAME:
EVALUATORS TITLE:
SCHOOL/ AGENCY:
STREET:
CITY:
PHONE:
EMAIL:
SIGNATURE:
DATE:
CATEGORIES
Leadership skills
Critical Thinking Ability
Motivation
Oral Expression
Empathy and Ability to work with Others
Self-confidence
Maturity
Reliability and Responsibility
Breadth of intellectual interest
RATING SCALE
SUPERIOR ABOVE AVERAGE
STATE:
AVERAGE
POOR
N/A
5. Please give an overall recommendation of the student for the Bellevue Summer Internship Program.
Highest recommendation
Strongly Recommend
Recommend as Satisfactory
Not Suitable at this time
Not Recommended
Insufficient Evidence to Evaluate
If you would like to share additional comments, please use the space provided below.
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______
Application
______
______
Resume
______
______
______
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