Observation Application

STOP! Until further notice, we are only accepting applications from candidates who have a Providence sponsor to job shadow. Please check back later if you do not have a sponsor. Thanks!

Thank you for your interest in an observation experience! Please take time to thoroughly review program highlights HERE before you apply.

New User Details

User ID

User ID (verify)

Password

Password (verify)

IDENTIFICATION

* Last name

* First name (legal)

* First name (preferred)

Middle name

* DOB

* Mailing address

Apartment

* City

* State

* Zip code

* Phone (cell)

Phone (home)

* E-mail

EMERGENCY CONTACT

* First and last name

* Relationship to you

* Phone (cell)

Phone (home)

Phone (work)

EDUCATION

Please select the highest level of education you completed.

* School

* Graduation date

Are you currently enrolled, or considering enrollment, in one or more of the following programs?

* If OTHER, please explain.

EMPLOYMENT

* Occupation

AREA OF INTEREST

Which department/role are you interested in shadowing?

* If you selected OTHER, what department/position are you interested in shadowing?

Do you have a Providence staff member who is willing to be your sponsor?

If you selected YES, please provide your sponsor's name and contact information.

* First and last name

Providence e-mail

Providence phone

AVAILABILITY

Please select which shift(s) you are available to observe.

* What is the first day you would be available to observe?

* What is the last day you would be available to observe?

* Please provide comments about your availability that would be helpful for us to know.

QUESTIONS ABOUT YOU

Are you a former or current Providence volunteer?

Are you a current Providence caregiver?

Caregiver Acknowledgement
I must notify my core leader of my intent to job shadow.
I must be in good standing, which will be verified with my core leader.
I will job shadow only during non-working hours when I am clocked out and officially off-duty.
My core leader is NOT expected to adjust my work schedule to accomodate a job shadow experience.
I am requesting to job shadow at my own inititative, free from any direct or implied request to do so from the ministry.

* By selecting the checkbox, you certify that (i) you are the individual completing this form, (ii) all information entered on this form is true and accurate to the best of your knowledge; (iii) you agree with all terms and conditions of the Caregiver Acknowledgement; and (iv) you consent to using the checkbox as the means of providing your signature electronically and that such electronic signature is a valid e-signature.

* In which department/unit are you a caregiver?

* Who is your core leader (first and last name)?

Have you notified your core leader of your intent to job shadow?

* If you have not notified your core leader of your intent to job shadow, please explain.

* To help us get to know you, please provide a brief summary of your background.

* What are your career goals and why?

* What do you hope to accomplish through a job shadow experience?

COVID-19 VACCINE AGREEMENT

In order to observe, you must be fully vaccinated against COVID-19. You are considered fully vaccinated if you received a single dose of the Johnson & Johnson vaccine or if you received two doses of the Pfizer or Moderna vaccine. Proof of vaccination will be required before your application will be approved.

Do you understand and agree that you must comply with this condition of job shadowing experience?

OBSERVATION AGREEMENT

If offered an observation experience:

I will uphold Providence's Mission and Values for the duration of my experience.

I will accompany my sponsor for the duration of my experience.

I will abide by all Providence policies and will follow the direction of my sponsor and other hospital caregivers.

I will not post references to my experience on social media.

I will not take any photographs during my experience.

I will not observe care being provided to a member of my family or a personal acquaintance.

I will not shadow a member of my own family.

I understand that failure to comply with Providence St. Joseph Health policies will result in immediate removal from my experience and I will forfeit any future opportunities.

I understand that violation of any policies related to confidentiality, even after my experience ends, may result in personal civil and monetary penalties, per state and federal law.

I understand that this experience is strictly observational and I will not provide any patient care, regardless of my experience and/or credentials.

I understand that I will be required to wear a Providence ID observer badge for the duration of my experience, and I will return it, as instructed, at the conclusion of my experience.

I understand that staff reserve the right to limit observations if safety or infection risks are present.

I understand that I am not entitled to and will not receive any compensation, salary, benefits or other payments in exchange for my experience.

I understand that participation in the shadowing program is not a guarantee of future paid work or placement as a volunteer.

I agree to release, indemnify, and hold harmless Providence St. Joseph Health, as well as all its employees, volunteers, agents, representatives, etc. from all losses, claims, theft, demands, liabilities, causes of action, or expenses, known or unknown, arising out of my participation in job shadowing activities.

* By selecting the checkbox, you certify that (i) you are the individual completing this form, (ii) all information entered on this form is true and accurate to the best of your knowledge; (iii) you agree with all terms and conditions as listed on this form; and (iv) you consent to using the checkbox as the means of providing your signature electronically and that such electronic signature is a valid e-signature.

* Date