Please complete the online registration process which includes submitting the following required forms. Forms can be downloaded below. Required fields are highlighted in yellow. Be advised you will not be able to submit this application until the forms below have been downloaded, completed and then uploaded at the bottom of this application form. All applicants MUST be at least 16 years of age in order to successfully apply.


1. HIPAA Form. Please click here to download.

2. Multimedia Consent Form. Please click here to download.

3. Nuvance Health Network Access Agreement Non-workforce Members. Please click here to download.

4. Nuvance Confidentiality and Information Access Agreement. Please click here to download.

5. COVID 19 Self Screening Attestation Form. Please click here to download.

6. Flu Consent/Declination Form. Please click here to download.

7. Parental Permission Form (IF UNDER 18 this must be signed!). Please click here to download.

All students must be AT LEAST 16 years of age in order to apply. You are able to submit your proof of COVID-19, Flu, and MMR/Varicella vaccination below, towards the end of the application. Selected applicants will be contacted for an interview. Further details will be provided upon acceptance.

Personal Information

Emergency Contacts

(Daytime)

Education

About You

Availability

Please indicate the days and hours you would prefer
Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday

References

Please list at least 2 recent references: (References must be a former/current employer or someone other than friend or family who can vouch for your character).

Reference 1

Reference 2

Reference 3

Tell Us More

Final Steps
I certify that the information in this application is correct to the best of my knowledge. I authorize the investigation of all matters contained in this application and agree that any misleading or false statements shall be cause for rejection of this application and will be cause for immediate dismissal.
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