Westerly Hospital

2. Apply Here for Clinical Observation

Please complete the application at least one month prior to your desired start date. If you have any questions or concerns, you may call 401-348-3969 or email WHVolunteerServices@YNHH.org.

NOTE: CURRENT YALE NEW HAVEN HEALTH SYSTEM POLICY REQUIRES OBSERVERS TO BE 18 OR OLDER

Application date

* First name

Nickname

* Last name:

* DOB

Gender

* Home Address

* City

* State

* Zip/postal

* Phone (Mobile/Primary)

Phone (Home/Secondary)

* E-mail

* Emergency Contact

* Emergency Phone

* Relationship

Is this a requirement for a clinical training program?

Please provide 2 references with email addresses. Personal or business, NO family members

* Reference 1 Name and Email

* Reference 2 Name and Email

Describe your interests and availability. Please include the department(s) that interest you, the week(s) when you have availability, and the days/times that you prefer. Note that your schedule will be based on the availability of the preceptors. We may not be able to accommodate all requests, but we will do our best.

Your signature will also be obtained during the interview acknowledging that you have read and understand the following. Please read this information carefully. I understand and fully acknowledge that, in observing at LMH, I am entering an AT WILL relationship and that this relationship can be terminated at any time by me or by LMH for good cause. I give permission for LMH to contact my references. It is my understanding that all information I provide to LMH is true and complete to the best of my knowledge. I understand that giving false information may be sufficient cause for immediate dismissal. I further understand that I may be asked to undergo training and/or testing as applicable.

Please check your spam for a confirmation email. When your application is accepted, you will receive a second email requesting your immunization records.