Post Graduate Nursing Internship - Roper St. Francis Healthcare

Roper Saint Francis HealthcarePost Graduate Nursing InternshipApplication FormDate: ____________________Legal Name: ____________________________________Address: __________________________________________City______________________State__________________zipcode_________E-Mail: _______________________Phone Number(s): ______________ Secondary Number: _________________How did you find out about this position? __________________________________If you were referred by a current employee, please provide his/her name anddepartment:_________________________________________________________If you have any relatives currently employed at Roper St. Francis Healthcare, pleaselist:________________________________________________________________Have you ever worked at Roper St. Francis Healthcare? ________If “yes”, when? ________________Have you ever been convicted (whether or not a sentence was imposed), or pleadguilty, or“no contest”, of any crime (felony, misdemeanor or summary) other than a minor trafficviolation? __________________If “yes”, please list the date and place of offense, the charges, and thedisposition. (The existence of a criminal record does not constitute an automatic barto the intern program.)______________________________________________________________________________________________________________________________________RN License:1) License Number:________________ Expiration Month/Year: ________2) State License Issued: _____________Education:College: __________________________________City, State: _______________________________Degree Awarded: ___________________________Mo/Yr (Date) Completion of Degree: ___________Application checklist:1) Official School transcript (only necessary if selected for interview)2) Completed Release (Hirease form)3) Letters of recommendation (see options above)4) Completed application form5) Copy of Current American Heart Association BLS for Healthcare ProviderCard6) Cover letter and resume