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

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 oneyear Nurse Residency Program in your unit of hire. Do you agree to these requirements?
Yes
If yes, please respond to the following questions.

No


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

(example) Senior Practicum
(example)
Advanced Care Partner

Approximate Dates

Total hours

November 2019

225 hours

January –
December 2019

12 hours/week

Name of Hospital and/or
Institution
Medical Center of the
Rockies
University of Colorado
Hospital

Name of Department or
Department
Description
Surgical ICU
ED