Full Name *

City/State/Zip *

Email Address *

Date of Birth *

Address *

Phone Number *

Last 4 digits of your social security number *

Education

University / College Currently Enrolled *

Program of Study

Contact Information for your school's Internship Director: (Name, Address, & Phone Information) *

1000

Starting date for your internship:

Preferred Location

Any Location
Lancaster County
Lebanon County
York County

Completion date for your internship: *

Employment Questions

Have you ever been convicted of a felony? *

Yes
No

Have you ever filed an application with us before? *

Yes
No

Have you ever been employed with us before? *

Yes
No

Are you prevented from lawfully becoming employed in this country because of VISA or Immigration Status? *

Yes
No

Authorization for Release of Information

I hereby authorize the release to WELLSPAN PHILHAVEN of any and all information relative to my internship, including but not limited to dates of employment, attendance records, performance ratings, rates of pay and eligibility for reemployment. I authorize its release without penalty or liability. A printed copy of this authorization shall be considered as valid as the original.

Electronic Signature *

Today's Date *

Personal Reference (No relatives or previous supervisors)

Name *

City/State/Zip *

E-mail Address *

Address *

Phone Number *

Professional Reference (No Relatives)

Name *

City/State/Zip *

E-mail Address *

Address *

Phone Number *

Authorization

I certify that answers given herein are true and complete to the best of my knowledge. I authorize investigation of all statements contained in this application for internship as may be necessary in arriving at an internship decision. I hereby understand and acknowledge that, unless otherwise defined by applicable law, any internship relationship with this organization is of an "at will" nature, which means that the intern may resign at any time and the organization may end the internship at any time with or without cause. It is further understood that this "at will" internship relationship may not be changed by any written document or by conduct unless such change is specifically acknowledged in writing by an authorized executive of the organization. In the event of internship, I understand that false or misleading information given in my application or interview(s) may result in ending the internship. I understand, also, that I am required to abide by all rules and regulations of the organization.

Electronic Signature (Type your full name to indicate agreement) *

Today's Date *

WellSpan Philhaven Application Supplement

In a few sentences, how would you describe your preferred work environment?

1000

Describe your understanding of mental illness.

1000

Describe one characteristic that you value in yourself and why.

1000

How have you handled the least interesting or least pleasant tasks assigned to you?

1000

How do you cope with sudden deadlines and changes in your workload?

1000

What distinguishes a great employee from a good employee?

1000

How will you contribute to WellSpan Philhaven's mission?

1000

Resume *

Accepted file types: .pdf, .jpg, .png

Captcha *

Education

Internship Requirements

Availability

Employment Questions

Authorization for Release of Information

Personal Reference (No relatives or previous supervisors)

Professional Reference (No Relatives)

Authorization

WellSpan Philhaven Application Supplement