M.D./Employees

Community Hospital Anderson Job Shadow Program

Thank you for your interest in a job shadow at Community Hospital Anderson! Please complete the information on this page and it will be submitted to the Human Resources Department.

As part of the application process, you will be required to read and agree to the terms of our Confidentiality Agreement and Acknowledgement of Responsibilities. You can read both documents using the link below. If scheduled for a job shadow, these forms must be printed and brought with you to the Human Resources Department. Parents of minors will also be required to read and agree to these terms.

Once you have completed this information, we will review and contact you regarding availability and scheduling of your request.

Confidentiality Agreement
Acknowledgement of Responsibilities

Note: Required fields are marked with an *

Contact Information

First Name: *

Middle Initial:

Last Name: *

Phone: *

E-mail: *

Are you a high school student? * Yes No


School Information

School Name:

Address:

City:

State:

Zip Code:

Is this request to fulfill a class requirement? Yes No
Please describe reason for request:


Community Hospital Affiliation

Please indicate your status:

Current CHA Employee
If yes, please provide title and department

Former CHA Employee
If yes, please provide name during time of employment, date and department

None of the above


Area of Interest

Please note that shadowing opportunities in your area(s) of interest may not be available at the time of your request.

Nursing

Specific Unit

Pharmacy

Laboratory

Physical Therapy

Occupational Therapy

Imaging Services

Speech Language Therapy

Other


Day and Time Preferences

M

T

W

Th

F

Sat

Sun

Days

Afternoons

Other


Agreement of Terms / Age Verification

I have read and agree to the Confidentiality Agreement

I have read and agree to the Acknowledgement of Responsibilities

I am under 18 years old