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Public Health Internship Program Application

Questions?

Contact the internship coordinator .

The Health Department selects applicants based on availability and department needs, and places applicants based on area of interest and expertise. Positions are limited due to staffing capacity and are offered on a competitive basis.

* Indicates required fields.
Internship Program Application (HDInternship@pima.gov)

I. APPLICANT INFORMATION

Name  *Phone 
Address City 
State Zip 
E-mail  *Referred by
Emergency Contact Emergency Phone 
Preferred internship type:    Virtual   On-Site   Hybrid   No Preference

Please send resume to HDInternship@pima.gov

II. STUDENT INFORMATION

College/University Name (if not enrolled, go to SECTION III): 
Current Degree Program (Certificate, Associates, Bachelors, Masters or PhD): 
Field of Study: 
Area of focus or interest: 

Are you seeking an internship for college credit or course/program requirement?  Yes   No

If yes, submit forms/documents related to your internship plan at HDInternship@pima.gov

College Preceptor Name:  
Requested Start Date:  
Total # hours of request:    # of hours available per week:  

Do you have your own project or project idea that you would like the Health Department to consider? Please describe:

III. GOALS

Please provide a short description of what you hope to accomplish while participating in a public health internship or volunteer experience at PCHD. *

IV. EXPERIENCE & SKILLS

List any relevant skills, training, certifications or licenses you possess.

V. PREFERENCES & AREA OF INTEREST

Please select the Top 3 program areas that would be most appropriate for your public health experience needs:

1. * 

2.   

3.   

Provide any additional information or considerations you would like to include: 

VI. VOLUNTEER/INTERN AGREEMENT

POLICIES AND PROCEDURES

As a PCHD volunteer/intern, I AGREE TO:
  • Support the mission, vision, goals, efforts and official positions of PCHD.
  • Promote goodwill by handling my responsibilities and contacts with staff, other volunteers, customers and visitors in a spirit of courtesy and cooperation.
  • Observe:
    • The Drug-Free Workplace Act of 1989;
    • Pima County policies that prohibit workplace harassment;
    • Pima County Privacy and Confidentiality rules;
    • Pima County IT Program policies;
    • Pima County policies related to disciplinary action, attendance, and rules of conduct;
    • The most current communication plan for reporting concerns with policies, practices or procedures; and
    • All policies and directives required by PCHD.

SAFETY, SECURITY, and CONFIDENTIALITY

As a PCHD volunteer/intern, I AGREE TO:
  • Report to my volunteer job physically and mentally fit for duty.
  • Observe all safety and security rules.
  • Report accidents, injuries, fire, theft or other unusual incidents immediately after the occurrence or discovery.
  • Refrain from using PCHD property, services or supplies for personal reasons unless given prior permission by the site supervisor.
  • Deal fairly with all PCHD colleagues, co-workers, supervisors, customers, visitors, and volunteers, without regard to their gender, race, ethnicity, religion, creed, age, sexual orientation, marital status, national origin, ancestry, citizenship, military status, veteran status, handicap or disability.
  • Contact the Volunteer/Internship Coordinator or another appropriate site supervisor immediately if I feel discriminated against or harassed in connection with my volunteering/internship.
  • Hold harmless PCHD, its agents, employees, directors and insurance carriers from any and all claims, damages and judgments which I may have now or in the future against the PCHD in all matters pertaining to my services as an agency volunteer, including, but not limited to, personal injury.

CONFIDENTIALITY and CONFLICT OF INTEREST

As a PCHD volunteer/intern, I AGREE TO:
  • Maintain and safeguard the confidentiality of all business, donor, employee, volunteer and client records, credit and financial information, and/or any information relating to the operation of the agency that is not known or readily available to the general public.
  • Avoid engaging in any conduct that is, or could be, perceived as a conflict of interest.

I understand that this volunteer/intern experience is unpaid, and by, signing and submitting this application, I agree to abide by the policies and procedures of PCHD during my time as a volunteer/intern, conforming to all rules and regulations commonly applied to employees of the agency, including but not limited to, safety, discrimination, harassment, confidentiality and position statements.

By submitting this application, I understand that failure to abide by these policies, procedures and rules is grounds for disciplinary action, up to and including, the dismissal from PCHD’s volunteer/internship program.

SIGNATURE

Signature *    Date *  
>Referred from Page: 



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