Student Experience Application

Primary Phone Number *

Hometown at time of high school graduation

Are you currently a St. Anthony Hospital employee?

Have you worked for St. Anthony in the past?

If YES, please provide approximate dates of employment and position / department.

Was your employment terminated by St. Anthony?

If YES, please explain.

Have you ever been convicted of a criminal offense other than a minor motor vehicle violation?

If YES, please explain.

Educational Institute(s) Name (Or Other Institute Name)

Educational Institute Address, City, State

Academic Course Coordinator (First and Last Name)

Academic Course Coordinator Phone Number

Academic Course Coordinator Email Address

Rotation Course Name (if known)

Current Major(s) Field of Study

Current Minor(s) Field of Study

Anticipated Date of Graduation

Start Date Requested *

End Date Requested *

Total Number of Hours needed at St. Anthony *

Type of Experience Requested *

Other Type of Experience:

What are your career goals? What prompted your request?

In the future, are you interested in working at St. Anthony?

Yes
No
Possibly

Is there anything else you would like us to know?

We would like to share a bit of information about you with our staff! Please write a short bio with some details about yourself (i.e. hometown, education, experience, interests/hobbies, etc.). If you do not wish to share any information, please type N/A. *

Please upload photo of yourself. (Head and shoulders please.)

I understand that St. Anthony may require my educational institution to attest to my criminal history background prior to me being permitted to participate in the program at St. Anthony.
I agree to disclose any change in status to criminal background history and understand that such changes in status may preclude my ability to participate in the program at St. Anthony.

By typing in your full name, you attest to the validation of your application.

If you are interested in completing a student experience, the first step is to complete the student application below.