Please complete this application form if you are interested in career PTA Career Observation at Ascension Sacred Heart. Once you complete the form, click the Continue button at the bottom.


Eligibility:

Students 18 years of age and older who are undergraduates or seeking enrollment in a college or university with an interest in a physical therapy assistant program. We are looking for mature, responsible adults who are willing to support our mission of service, excellence with professionalism, and courtesy.



Contact Information:


Have you received your COVID Vaccine?

The COVID vaccine is a requirement, if you do not wish to receive the vaccine you are ineligible to volunteer at this time.



Demographic Information

You may optionally provide the following information. It is used only to help us get a better idea of the demographic make-up of our volunteers.



School Requirement - Verification

Are you needing hours to fulfill a school requirement? 

If you are a college student already in a healthcare (accredited) program please contact Student Onboarding at: student.onboarding@shhpens.org

All others please answer below:



Emergency Contact

In the event of an emergency whom should we notify?




Disclosure Regarding Background Investigation:

Ascension ("the Company") may obtain information about you from a third party consumer reporting agency for employment purposes. Thus, you may be the subject of a "consumer report" and/or an "investigative consumer report" which may include information about your character, general reputation, personal characteristics, and/or mode of living and which can involve personal interviews with sources such as your neighbors, friends, or associates. These reports may contain information regarding your credit history, criminal history, social security verification, motor vehicle records ("driving record"), verification of your education or employment history, or other background checks. Credit history will one be requested where such information is substantially related to the duties and responsibilities of the position for which you are applying.


You have the right, upon written request mace within a reasonable rime, to request whether a consumer report has been run about you, and disclosure of the nature and scope of any investigative consumer report and to request a copy of your report. Please be advised that the nature and scope of the most common form of investigative consumer report is an employment history or verification. These searches will be conducted by Universal Background Screening, Inc., Post Office Box 5920, Scottsdale, AZ 85261, 1-877-263-8033, www.universalbackground.com. The scope of this disclosure is all-encompassing, however, allowing the Company to obtain from any outside organization all manner of consumer reports throughout the course of your employment to the extent permitted by law. 



Commitment Acknowledgement:

Due to the time and expense of onboarding PTA career observation students, Ascension Sacred Heart Pensacola requires a commitment to obtain all 48 observation hours (acute care, outpatient rehab, and long-term care facility) required by Pensacola State College to be obtained at one of our facilities. Observation hours for other college/university programs will be considered on a case-by-case basis.



Affirmation Statements:

I agree to abide by all of Ascension Sacred Heart Health System policies and procedures which include the dress and appearance policy for observers. I agree that as I participate in the PTA Career Observation experience program my role will be as an observer only and I will not be permitted to provide direct patient care or participate in any patient procedure.

At all times, I must be under the supervision of an associate. In addition, I understand that patients may exercise their rights to not participate in the PTA Career Observation experience program.

I understand that in the course of my PTA Career Observation experience I may come into contact with confidential patient information. I will not at any time during or after my experience at Ascension Sacred Heart Health System disclose any patient information to any person or use patient information, other than necessary.

I understand that participation in this program is voluntary and without compensation and that Ascension Sacred Heart Health System is not responsible for any expenses incurred during, or as a result of, my participation in the PTA Career Observation experience program.

In consideration for participation in the PTA Career Observation experience program, I hereby waive, discharge and agree to hold harmless Ascension Sacred Heart Hospital, it's agents and employees from any and all liability, claims, demands, and actions arising out of or relating to any loss, liability, damage or injury sustained by me, or any property belonging to me while participating in the program.



Criminal Background History Consent & Statement

I hereby give my consent to conduct a criminal background history through the local county clerk of court records.
I understand that this information will be used to determine my eligibility for job shadowing at Ascension Sacred Heart Hospital.
I waive and release Ascension Sacred Heart and its agents from any and all claims I may otherwise have with respect to any such criminal background check.