Thank you for your interest in Watertown Regional Medical Center (WRMC)!
 
Note: If you are interested in applying for employment at Watertown Regional Medical Center, please return to the www.watertownregional.com webpage.
   
Application
Below you will find an application for individuals interested in a one day job shadow, a student experience or volunteering with details including any pre-requisites, considerations for determining appropriate applicants and requirements for participation. This information will enable our Human Resources team to determine eligibility for an experience within our organization.

This application must be fully completed prior to being considered for an experience.
Prior to any placement, all requirements must be fully completed and on file at WRMC as directed.
 
For more information on completion of requirements, please reference the "Student FAQ's" at this location http://www.watertownregional.com/work-at-wrmc/student-faqs
 
1. Interested in a one day job shadow to explore a future career AND meets one or more of the following prerequisites:
a.      Applicant is a current employee or volunteer of WRMC.
b.      Applicant is an immediate family member of a current employee of WRMC.
c.      Applicant is a student who has been accepted into or enrolled in a program that requires a job shadow.

Requirements for consideration and participation:
 
-Complete this survey application

-If accepted, applicant will receive and must read and acknowledge provided orientation materials and attest to HIPAA compliance

-Fulfill any other requirements as requested by the organization.
  
2. Interested in volunteering, seeking an internship or student/clinical experience lasting greater than one day.

Requirements for consideration and participation:

 -Complete this survey application

 -Provide documentation of 2 doses MMR vaccine (or positive titer to each measles, mumps and rubella), 2 doses Varicella vaccine (or positive titer), one dose Tdap, and 3 doses Hepatitis B (or positive titer or declination form). During the months of October through March, proof of seasonal influenza vaccine required.

-Provide record of TB skin test or Quantiferon Gold results less than one year old.

-Provide documentation of an 8-panel, or higher, forensic drug screen, completed no more than 30 days prior to the start of the internship.

-Provide documentation of a recent criminal background check (WI Caregiver Background Check preferred).  

-Fulfill any other requirements as requested by the organization.

* 1. First Name

* 2. Middle Name

* 3. Last Name

* 4. Date of Birth

* 5. Address

* 6. City

* 7. State

* 8. Zipcode

* 9. Email Address

* 10. Home/ Mobile Phone

* 11. Emergency Contact Name, Relationship to you and Phone Number

* 12. Tell us about yourself: In the field below, please describe yourself and why you are interested in an experience at Watertown Regional Medical Center.

* 13. Name of School/ College/ University

* 14. Grade/ Year in School/ College/ University

* 15. Requested Start Date (For a Job Shadow or Internship Experience only)

Note: Due to our commitment to Patient Centered Care and the resources required to provide this type of experience,  Watertown Regional Medical Center requires at least a month's notice prior to scheduling a student experience.

* 16. Please choose one of the following types of experiences:

* 17. If you are under 18 years of age, a parent or guardian must give permission for participation in an experience at Watertown Regional Medical Center.

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