INFORMATION: Last Name: Given Name(s): School of Nursing: Nursing Program: RN RPN Nursing Program start date (m/d/y): Expected program completion date (m/d/y): As of April 1, 2016 I will have completed term of my Nursing Program. Are you currently employed as an Employed Student Nurse with another Health Authority? Yes Health Authority: No Availability: Successful candidates will partake in week long Nursing orientation prior to starting ESN shifts: 2016 Nursing Orientation dates are: April 12 15 – May 3 6 – June 7 10 – July 5 8 – August 9 12 – Please advise Which Month (April 2016 or after) you will be AVAILABLE to start: Please provide the following information on your previous clinical placements: Facility Unit Dates & SchoolTerm Length of Placement Description (m/d/y) (approximate number of (i.e. ’s Hospital, MSJ, , etc.) hours) (i.e. medicine, surgery, psychiatry, etc) Briefly describe your future career goals:
INFORMATION: Last Name: Given Name(s): School of Nursing: Nursing Program: RN RPN Nursing Program start date (m/d/y): Expected program completion date (m/d/y): As of April 1, 2016 I will have completed term of my Nursing Program. Are you currently employed as an Employed Student Nurse with another Health Authority? Yes Health Authority: No Availability: Successful candidates will partake in week long Nursing orientation prior to starting ESN shifts: 2016 Nursing Orientation dates are: April 12 – 15 May 3 – 6 June 7 – 10 July 5 – 8 August 9 – 12 Please advise Which Month (April 2016 or after) you will be AVAILABLE to start: Please provide the following information on your previous clinical placements: Facility (i.e. ’s Hospital, MSJ, , etc.) Unit Description (i.e. medicine, surgery, psychiatry, etc) Dates & SchoolTerm (m/d/y) Length of Placement (approximate number of hours) Briefly describe your future career goals:
PHC%20ESN%20Application%20Form%202016_0.docx