Nursing Referral Form

UM Nursing
Shadow a Nurse Application

Recruitment/ Retention Info:

Ctr. for Professional Dev't & Mentoring (CPDM) new!

Career Resource Center

Available Positions

Nursing Benefits

Nursing Classifications

Maps/Directions

Recruitment Event Calendar

Central Nurse Orientation

Student Nurse Employment

Foreign Nurse Employment

Questions? Call 1.877.NURSE.UMHS anytime and a recruiter will return your call.

For Retention Team, call Juanita Parry at 734.647.9214
Or contact us online.

Meet our Recruitment/Retention Team.

Recruitment/Retention home

We are delighted in your interest in shadowing a nurse.
The shadow program is open to students currently enrolled in an ADN program or licensed RNs looking at the University Health System for possible employment.
If you meet one of these qualifications, please fill out the application and submit for review. You will be contacted within 72 hours of receiving the completed application by a representative of the Nurse Recruitment Department.

Last Name:

First Name:

Phone No(s):

1
(2 )

Email:

Address:

City:

Zip:

Titles:

RN ADN BSN LPN
2nd Degree Program

If nursing student, please answer next 2 questions:

1) School you're attending:

2) Current year in Nursing Progam:

BSN Students:
Freshman	Sophomore	Junior	Senior
ADN Students:
1st year	2nd year

AREA(S) OF INTEREST
If interested in multiple units, please rank top 3 choices:

Freshman/Sophomore nursing students currently enrolled in a BSN program or 1st-year students currently enrolled in an ADN program, please elect from only the following areas:

Adult step-down	Adult Surgery	Adult Gen. Med.
Ped Hem/Onc	Ped Med/Surg

Junior/Senior nursing students currently enrolled in a BSN program, 2nd-year students currently enrolled in an ADN program, please elect only from the following areas:

Adult step-down	Adult Surgery	Adult Gen. Med.
Ped ICU	Ped Hem/Onc	Ped Med/Surg
Ped Cardio/Thor	Surgery ICU	Trauma Burn ICU
Cardiac ICU	Psychiatric	Thoracic ICU
Medical ICU

YOUR AVAILABILITY
Check each time you are available for the specified day of the week (if you are not available that day, do not check a time). Please keep in mind it could take up to a month to schedule the shadow, days/times of avilability should be open.

Mon.	Tues.	Wed.	Thurs.	Fri.	Sat./Sun.
7am	7am	7am	7am	7am	7am
3pm	3pm	3pm	3pm	3pm	3pm
7pm	7pm	7pm	7pm	7pm	7pm

How did you hear about this program?

Responses to this form are sent to Angela Kerner: angelajm@med.umich.edu

CREATE YOUR CAREER WITH US...

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