Student Intern/Rotator Application

**  Please DO NOT COMPLETE THIS APPLICATION until you have a confirmed placement.  Thank you for your cooperation.  **

Please complete all required fields highlighted in yellow.

PERSONAL INFORMATION

If you are neither a U.S. Citizen nor Green Card holder, you will need clearance from the Mount Sinai International Personnel (IP) Department prior to being placed as a volunteer.

If you are an International Applicant, please fill out:

EDUCATION

College/University

Please indicate highest level degree.

Additional Education

RESUME

EMERGENCY CONTACT

CONNECTIONS TO MOUNT SINAI

Internship/Externship/Rotation Information:


AGREEMENT

I understand and agree that:
  • I certify that the information contained in this application is correct to the best of my knowledge. I authorize investigation of all matters contained in this application and agree that any misleading or false statements could be cause for rejection of this application or would be sufficient cause for dismissal from a volunteer placement at the Mount Sinai Hospital. I understand that my volunteer placement is contingent upon satisfactory completion of a toxicology screening and a health screening by a Mount Sinai Employee Health Service practitioner or private physician, the receipt by Mount Sinai of a satisfactory reference and my satisfactory completion of the probation period. I hereby authorize my present/past employers to furnish Mount Sinai with my records of service.
  • If I am accepted as a volunteer, I authorize Mount Sinai Hospital to conduct any and all verifications as permitted by Federal, State and municipal codes and regulations. I agree to abide by all Mount Sinai rules and regulations. I agree to follow Mount Sinai policies with respect to a drug-free workplace and I affirm that I do not use un-prescribed controlled substances and/or any illegal substances. I understand that my volunteer service is not governed by any written or oral contract and is considered an "at will" arrangement. This means that I am free, as is Mount Sinai, to terminate the volunteer relationship for any or no reason, as long as there is no violation of applicable Federal, State or Local law.
  • I understand that the volunteer clearance process is highly selective and that the completion of the volunteer application does not guarantee a volunteer placement at Mount Sinai Health System. In consideration of any volunteer opportunity which may be offered to me, I agree to comply with the policies, rules, regulations and procedures of Mount Sinai. This application will remain current for 90 days. If I have not then been on boarded as a volunteer by Mount Sinai within this timeframe, I understand that I may need submit a new application to remain eligible for volunteer consideration.
My name below will stand as my signature, confirming the completeness and accuracy of the information I provided above, and will carry the same force and effect as if it were signed and affixed by my hand.