2017 High School Summer Internship Application Overview for the Central Valley Area (Stockton, Manteca, Tracy, and Modesto)

During this internship, interns gain transferrable work skills and health care career exposure through administrative experiences, including project coordination and office functions. Interns will not participate in clinical procedures. During the summer, KP LAUNCH interns in the program will:

Work full-time, Monday through Friday, for an eight-hour work shift during the program starting on June 12, 2017 and ending on August 4, 2017

Learn about different career options that they can pursue in healthcare Work independently on various healthcare-related projects in office or clinical settings working

with at least one manager in a specific department Participate in weekly KP LAUNCH professional development days with other interns to enhance

their career development In order to become part of the KP LAUNCH program, you must:

Complete the paper application form and attach your resume and personal statement Submit a KP LAUNCH Minor Consent Form if you will be 16-17 years old before August 4, 2017 Be selected to complete an in-person interview Be selected to participate in the program, and Complete all Kaiser Permanente pre-employment requirements

There are a limited number of internship positions available nearby each Kaiser Permanente Medical Center throughout Northern California. Not everyone who applies will be selected to interview or to participate in the program. Applicants must apply for the program based at the Kaiser Permanente medical center closest to the applicant's home address. The program in the Central Valley Area supports the Stockton, Manteca, Tracy, and Modesto facilities. Selected interns are planned to receive an invitation to participate in the program by March 31, 2017. Applicants who are dependents of Kaiser Permanente employees are not eligible to participate in KP LAUNCH summer internship programs. How to Apply

1. Complete the 2017 KP LAUNCH internship program application form, and make sure that it is signed. a. If you will be 16 or 17 years old before August 4, 2017, complete a Minor Consent Form with

your legal guardian. 2. Write your personal statement (details on page 2 of this document) 3. Prepare a basic resume summarizing your contact information, academic (school) information and

work/volunteer experience (if any). 4. Submit your application form, personal statement, minor consent form (if applicable) and resume in

person to the Kaiser Permanente facility in Modesto on the specific submission dates (details listed on the next page).

CONTINUE TO PAGE 2

Personal Statement In 750 words or less, type or legibly write a personal statement to help us determine if this program is right for you. Write about yourself and your goals. In your writing, be sure to answer the following:

1. What education and career paths are you currently interested in? 2. How have you been impacted by:

a) your family's background or educational history, and b) your surrounding environment or community?

3. Are there any situations or barriers you think may prevent you from pursuing an education and doing well in school?

4. Who has inspired you to achieve success? How did this person inspire you? 5. Why do you think you should be selected to participate in this program?

Submitting your Complete Application Materials Completed applications must be submitted in-person by the student applicant between the hours of 2-5pm on Friday, March 3rd, and Monday, March 6th ONLY at:

Kaiser Permanente Modesto Medical Center, 4061 Dale Road, Modesto, CA 95356

at the HMH Trailer Modular Offices located West of the Emergency Room entrance and helicopter pad,

in the Break Room across from the Human Resources office (a sign will be posted).

NOTE: Applications will ONLY be accepted in hard copy, paper form (no email, fax, or other electronic manner), in person from the student applying, on March 3 or 6, between the hours of 2pm and 5pm. Applications submitted any other time or by any other means will not be considered.

If you have any questions about the KP LAUNCH summer internship programs, visit the website. After reviewing the website and still have any questions, please (510) 625-5401.

COMPLETE APPLICATION CHECKLIST (Please check as completed): Internship Application Overview (these 2 pages) Completed, signed application form (3 pages) Applicant and Parent Acknowledgement of Timelines form (1 page) Minor consent form (if applicable) Resume Personal Statement

PAGE 1

2017 HIGH SCHOOL PROGRAM APPLICATION FORM for the Central Valley Area (Stockton, Manteca, Tracy, and Modesto)

PROGRAM REQUIREMENTS VERIFICATION NO YES

Will you be under the age of 16 after May 31, 2017?

Will you be over the age of 19 years old before August 4, 2017?

Will you be attending summer school during the summer 2017?

Will you be going on vacation on any day(s) between Monday and Friday this summer?

Will you be attending any high school or college orientation days between 6/12 and 8/4?

Do you have a parent or legal guardian working for Kaiser Permanente?

If you answered YES to any of the questions above, please explain in the space below.

EMPLOYMENT DETAILS NO YES

If hired, you will be required to furnish proof that you are legally authorized to work for Kaiser Permanente in the United States. Please visit the following website to review acceptable employment eligibility document: https://www.uscis.gov/i-9.

Can you furnish such proof?

Employees are required to undergo and pass an employment background check if the employee is 18 years old or older by the start of the program.

Will you be 18 years old or older on or after March 31, 2017?

If selected to participate in the program, KP LAUNCH interns are required to work fulltime, Monday through Friday, for an eight-hour work shift for all days between June 12, 2017 and August 4, 2017 (except Tuesday, July 4). Are you able to fulfill this work requirement?

If you answered NO to any of the questions above, please explain in the space below.

PERSONAL INFORMATION

LAST NAME FIRST NAME MIDDLE INITIAL

STREET ADDRESS PHONE NUMBER

CITY ZIP CODE

EMAIL ADDRESS

PAGE 2

BACKGROUND

Have you been exposed to careers in health care? ☐ Yes ☐ No

If yes, how?

What are your parents’/legal guardians’ educational background? Place an “X” or checkbox besides the most applicable response.

Mother or Parent/Guardian 1

Father or Parent/Guardian 2

Did not complete high school Graduated from high school or attained G.E.D.

Completed some college Associate’s Degree or Training/Certificate Program

Bachelor’s Degree MASTER’S, Graduate or Professional Degree (MBA, MS, MD, PhD, etc.)

Unknown What is the best estimate of your family’s household income? (before taxes from all sources) ☐ $20,000 - $35,000 ☐ $35,000 - $50,000 ☐ $50,000 - $65,000 ☐ $65,000 - $80,000

☐ $80,000 - $95,000 ☐ $95,000 & higher

How many people live within your household?

☐ 1-2 ☐ 3-4 ☐ 5-7 ☐ 8 OR MORE

INTERNSHIP INFORMATION

Some internship departments are seeking interns who have different levels of experience with different computer software. Previous experience with these activities is not a requirement to participate in the program.

Please indicate with an ‘X’ if you have completed the following types of projects in the past: NO YES

Created a PowerPoint or other computer-based presentation

Completed a verbal presentation in front of 5 or more people

Entered data into an Excel spreadsheet or other database software

Calculated data while using Excel or other database software

Used Microsoft Access to enter or retrieve information

Rank the following healthcare careers that interest you the most, labeling 1 as most preferred, and 4 as least preferred. If you are unsure, you may leave this section blank. _____ Administration & Support Services _____ Human Resources _____ Information Technology _____ Clinical Positions

In preference order, list three careers that interest you the most: If you are unsure or undecided, you may leave this section blank. 1. 2. 3.

PAGE 3

APPLICANT STATEMENT

To the Applicant: Kaiser Foundation Health Plan, Inc., Kaiser Foundation Hospitals (KFHP/H), KFHP/H’s subsidiaries, Southern California Permanente Medical Group, and the Permanente Medical Group, Inc. (“Kaiser Permanente”) are equal opportunity and affirmative action employers. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, protected veteran status, or disability status Qualified applicants with arrest and/or conviction records will be considered for employment in a manner consistent with federal, state and local laws, including but not limited to the San Francisco Fair Chance Ordinance. Kaiser Permanente provides applicants who have disabilities with reasonable accommodations to assist in the interview/hiring process. Applicants requiring accommodations should contact the human resources office. Kaiser Permanente is a smoke-free workplace. This document must be completed in its entirety before an offer of employment can be authorized.

I understand that the Kaiser Permanente LAUNCH INTERNSHIP Program guidelines for eligibility require

that I must be a high school student or a recent high school graduate. If I am under the age of 18, I must

obtain a work permit and the consent of a parent or guardian. I am not eligible for this program if I have a

parent or legal guardian employed by Kaiser Permanente. This application is submitted with the understanding that all job offers are conditional and will not be confirmed until satisfactory completion of a pre-employment health screening and urinalysis drug test. I hereby consent to such required screening and drug testing. I hereby authorize Kaiser Permanente to solicit all information relevant to this application. This authorization includes but is not limited to, my academic background, my references, and my employment history. If I am over 18, I also understand that I will be required to complete the Kaiser Permanente job application in addition to this application and that Kaiser Permanente will perform a criminal background check. I authorize and request all persons, schools, employers governmental, law enforcement and other agencies to release such requested information to Kaiser Permanente. I also understand that all job offers are contingent upon receipt of satisfactory verification of all of the above information including verification of my ability to perform the essential functions of the position that I have applied for. I certify that the answers I have provided above are true, correct and complete and that I have not knowingly withheld any facts. I understand any falsification, misrepresentation or omission of facts are sufficient reasons for disqualification from further consideration for employment or dismissal at any time during employment should I become employed at Kaiser Permanente. I also understand that if I am employed by Kaiser Permanente, my employment can be terminated at any time with or without cause and with or without notice. I understand that a copy of this document is available to me if I so desire.

APPLICANT’S SIGNATURE: DATE:

Applicant and Parent Acknowledgement of Timelines Form APPLICANT NAME: PARENT/GUARDIAN NAME:

Carefully review all iformation provided below before completing and signing this document as changes will not be acceptable at a later time.

Timelines and Requirements

Be aware that you will receive further specific information at a later date.

Available? Yes / No

If no, please state reason

Additional Notes- Please read all information before signing

Date and Activity

INTERVIEWS to be conducted in Modesto, 5pm-9pm: March 13 (Stockton applicants)March 14 (Manteca/Tracy applicants)March 16, (Modesto applicants)

Mandatory HR Recruitment Information Session: April 14, 2017 at 4:00 pm - 5:30 pm Requires the attendance of applicant and one parent/guardian only

*Only selected candidates will be contacted via phone and scheduled for next steps.

"Give Every Child a Chance Orientation" - May 3-4, 2017 3:30 pm - 6:00 pm in Manteca, location to be confirmed

May 2017 - Drug Screening(*DS); Background Check; Employee Health Screening (*EHS); On-Boarding Location/Date/time to be determined

KP LAUNCH Program - June 12, 2017 - August 4, 2017 8-week program, Monday through Friday, 8 hours, Day shift. Attendance of ALL days are required.

*DS & EHS are in person and only done during the business hours of 8:30 am - 11:30 am and 2:00 pm - 4:00 pm.

*If you are a minor you MUST be accompanied by a Parent/Guardian for all appointments- NO EXCEPTIONS

*Dates/Times/Locations are subject to change based on program needs

Applicant Signature

Parent/Guardian Sinature

Date

Date

By signing this document you acknowledge that you have read and understand the above stated timelines and requirments for obtaining a position and participating in the entire 8 weeks of the 2017 KP Launch Program.

PARENT / LEGAL GUARDIAN CONSENT FORM

(To be completed if applicant will be under 18 during Summer 2017 pre-employment and program)

We are pleased to consider your child for the 2017 KP LAUNCH High School Internship Program. Please complete this parental/legal guardian consent form and have your child return it with his/her completed KP LAUNCH application. Thank you for your cooperation. My child, ________________________________________________________________________________ (PRINT APPLICANT’S FULL NAME HERE) has my consent to participate in the KP LAUNCH High School Internship Program should he/she be selected as an Intern. I assume all responsibility for his/her service in this Program to be in accordance with the policies, procedures, and expectations of Kaiser Permanente employees. I have reviewed the description of the Program. My child may participate in all activities in connection with his/her assigned duties, with or without accommodation.

I am the parent/legal guardian of _______________________________ (date of birth: ________________ ) , (APPLICANT’S FULL NAME,) a minor child ("________________________"), who has applied for a position as KP LAUNCH high school intern (APPLICANT’S FIRST NAME) in the Kaiser Permanente Medical Office Building located at _______________________________, California. (Address of Kaiser Permanente Facility) On behalf of the applicant, I hereby consent to provision to him/her/them by Kaiser Permanente of any or all of the following pre-employment screenings, tests and/or vaccinations as required by Kaiser Permanente policy and/or California law: Pre-employment health screening, tuberculosis and infectious disease testing, including any chest X-ray as

required to determine tuberculosis following the initial test;

Urinalysis test to determine the presence of use of illegal drugs; and

Either blood testing to confirm immunity, or appropriate vaccinations, but only if vaccination records or historical blood tests do not confirm immunity to measles, mumps, rubella, chicken pox or hepatitis B.

I also consent to use of the results of such required and drug testing by Kaiser Permanente in the pre-employment process and the determination of the applicant's suitability for employment.

I hereby authorize Kaiser Permanente to solicit all information relevant to my child’s application. This authorization includes an academic background check, and employment history. I authorize and request all persons, schools, employers, governmental and other agencies to release such requested information to Kaiser Permanente.

In the event I cannot be contacted, I hereby give permission for Kaiser Permanente to administer emergency health care to my child.

I give Kaiser Permanente permission to furnish transportation and to transport my child to special events or as needed as a condition of employment. I, forever release Kaiser Permanente and any affiliated organization, and their respective directors, officers, employees, volunteers, agents, contractors, and representatives (collectively “Releasees”) from any and all actions, claims, or demands for injury, death, or property damage, related to my child being transported as part of the KP LAUNCH internship program.

This permission is valid only during the intern’s working hours at Kaiser Permanente and for the duration of the KP LAUNCH High School Internship Program to which my child is applying, with the exception of any photographs/video recordings taken as they may be granted use by Kaiser Permanente to be used after the summer program ends.

__________________________________________________________ ________________ Parent/Guardian Signature (required for applicants under 18 years of age) Date