PROF-UCHealth-Nurse-Residency-Exemption-Application-Mar-2020

You will also be required to sign a financial contract stating your commitment to work for one full year following the one-year Nurse Residency Program in your unit of hire.. Yes No If

EXEMPTION SUBMISSION Supplemental Application

Name:

_

Graduation Date (or anticipated Graduation Date):

_

School Name (State, if not CO):

Current UCHealth Employee? Yes No If yes; in what role, facility, and department?

Reason for Exemption application submission:

 If applying with 1-6 months of RN experience, please also provide: o Exact dates (month/year – month/year) of employment as an RN:

_ o Location of RN experience:

_ o Facility name:

During the one year Nurse Residency Program you will be required to attend monthly residency seminars, clinical specialty classes and work a staff nurse schedule, which may include 12-hour rotating day/night/weekend and holiday shifts You will also be required to

sign a financial contract stating your commitment to work for one full year following the

one-year Nurse Residency Program in your unit of hire Do you agree to these requirements?

Yes No

If yes, please respond to the following questions

EXEMPTION SUBMISSION Supplemental Application

1 List the top three clinical units/areas in which you would like to apply and WHY you feel this

would be a good professional fit (Please refer to the website for unit descriptors.) #1

#2 #3

2 As a UCH employee, you will be held to the UCHealth standards of excellence, these include

a commitment to service, quality, teamwork, personal responsibility and communication

Discuss a professional experience in which you exemplified one of these standards of excellence (Word count limit: 250)

3 Share with us an accomplishment you are most proud of professionally (Word count limit: 250)

4 Describe any leadership or volunteer activities you have participated in that have contributed

to your professional growth (Word count limit: 250)

**If you have applied for an Adult ICU, Neonatal ICU or ED position, you must have participated in either a “paid” or “unpaid” clinical experience in an area of critical care

Please use the template below to outline your experience(s) to meet this eligibility requirement If you do not have any prior healthcare experience, feel free to delete this

table**

Type of Experience Approximate Dates Total hours Name of Hospital and/or

Institution

Name of Department or Department Description

(example) Senior Practicum November 2019 225 hours

Medical Center of the

(example)

Advanced Care Partner January –

December 2019

12 hours/week University of Colorado

Hospital

ED