Additional Extern Application Information - SEhealth.org

Information for Nursing Extern Employment Option
Please fill out and return to Ginger Anderson
by email ganderson@SEhealth.org, by fax 573-986-5934 or by mail:
Residency Program, 1701 Lacey Street, Cape Girardeau, MO 63701
Name:
Address:
Telephone Number:
Email:
Name of Program Currently Enrolled in:
Date of Graduation:
GPA:
Please provide copy of transcript
BLS Healthcare Provider Expiration Date:
Are you currently employed by Southeast Hospital
Are you interested in a tuition assistance program
In addition to the Nurse Extern paperwork, each applicant must also fill out a hospital
application. If you are already an employee at Southeast you must complete a Job Opportunity
form found on the Intranet and send to Human Resources. It can be found on this website under
Nursing jobs: Nurse Extern.
Please have one of your instructors to complete a reference using the form available on the
Nurse Extern webpage.
Include a copy of your transcript as part of your application.
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Nurse Extern Area of Interest Survey
Name: ________________________________________________________________
Please return with your application.
Please identify your areas of clinical interest by using the following ranking system:
1 = Very interested 2 = Interested 3 = Not interested
___ Cardiac Progressive Care Unit
___ Cardiovascular Lab
___ Inpatient Rehabilitation
___ Perioperative Nursing (OR & Peri-anesthesia Care Unit)
___ Emergency Department
___ Endoscopy Services (GI Lab)
___ Home Health
___ Hospice
___ Intensive Care Unit/Cardio-thoracic Unit
___ Joint Replacement Center/Orthopedics
___ Medical Surgical Nursing
___ Neuromedicine/Neurosurgery
___ Nursery/NICU
___ Obstetrics/Labor & Delivery
___ Oncology
___ Pediatrics
___ Psychiatric
Page 2 or 2 Revised February 2013