[Scotland County] Student Internship Application

Student Internship Application

Scotland County Health Department is always looking for passionate and talented individuals who would like to kick-start their careers through participation in our Internship program. To be considered, please complete the below form in its entirety. Thank you for your submission!

Your institution/school must have a contract with Scotland County Health Department before being considered for an internship opportunity. An existing contract with your institution/school and Scotland County Health Department does not automatically offer an agreement for placement within Public Health.

Requested Internship Program

Nursing

Environmental Health

Social Work

Health Education

College / University:

Home Phone Number

Cell Number

Drivers License Number

State

Are you 18 years of age or older?

Yes

Are you currently employed with Scotland County?

Yes

Acknowledgement of Workers’ Compensation Coverage:

Upon the submission of this application, I hereby acknowledge that I am not an employee of Scotland County Health Department or Scotland County and I am not covered under Scotland County’s Workers’ Compensation policy.

Name of Emergency Contact

Phone Number

Certification of Information Provided:

I hereby certify and attest that the above informaton provided is true, correct and complete. I understand that any falsification of information will disqualify me from my current and / or future student internship programs opportunities with Scotland County.

Student / Intern Signature

First Name

Last Name

Choose how to sign

Draw Type

Print Name of Parent / Guardian if applicant is a minor: