Microsoft word - sna application packet 5-12-10.doc

800 University Bay Drive
Madison, WI 53705
UNIVERSITY OF WISCONSIN HOSPITALS AND CLINICS
Student Nurse Assistant
Application Packet
Thank you for your interest in the UW Hospital and Clinics. You must have completed at least one nursing clinical rotation and be enrolled in an accredited BSN School of Nursing program to qualify as an SNA. Please read and follow the GENERAL INSTRUCTIONS, then return the attached materials for consideration. GENERAL INSTRUCTIONS:
Included in this packet is a Fact Sheet for you to keep as reference material. Please complete and return the attached: (a) Reference Release Forms (print 2 copies of this form) (to be completed by clinical instructors) Skills Inventory (to be completed by applicant) Complete the on-line application for the Student Nurse Assistant position, found on our website at www.uwhealth.org – go to careers at UWHC and then find the Student Nurse position. YOU MUST COMPLETE ALL OF THE ABOVE TO BE CONSIDERED FOR
EMPLOYMENT.
3.
UW Hospital and Clinics Nursing Recruitment 800 University Bay Drive Madison, WI 53705 Any questions, please call (608) 261-0040 or 1-800-443-6164
Minimum Qualifications:
1) Current enrollment in an accredited BSN School of Nursing program
2) Successful completion of Clinical I
3) Current CPR certification
Application/Hiring Process:
1) Please return completed application packet (questionnaire, skills inventory, and
UWHC application/background information disclosure) to Nursing Recruitment.
Note: The skills inventory is used as a guide to your competencies. This information will be shared with the Clinical Nurse Manager (CNM) during the interview process. 2) Provide “Reference Release Form” to two clinical instructors. It is your responsibility to
ensure that completed reference release forms are returned to Nursing Recruitment. The
Reference Release Forms may also be faxed or e-mailed. (See form for details.)
3) Nursing Recruitment will schedule you for an interview with an appropriate CNM,
taking into consideration unit vacancies and your experience, preferences, and clinical
instructor’s reference.
Position Description:
The Position Description for Student Nurse Assistant (SNA) is attached for your review. This describes all the
duties you will be expected to perform.
Salary:
$12.00/hour for hours worked. $1.00 differential for weekend shifts.
Schedule/Orientation:
Hours are posted for a four-week period. Shifts are usually 7:00 a.m. to 3:30 p.m.; 3:00 p.m. to 11:30 p.m.;
or 11:00 p.m. to 7:00 a.m. You will be scheduled regardless if school is in session or not, your Clinical
Nurse Manager will discuss scheduling expectations. Your orientation includes New Employee Orientation
and Student Nurse Assistant Orientation which must be completed before you begin working on the nursing
unit or clinic.

Graduation:
SNAs who are a December graduate and have been offered and accepted a position as a new graduate,
must start in the January group or resign within one month of graduation. SNAs who are May graduates
and have been offered and accepted a position as a new graduate must start in the June or July group or
resign within one month of graduation.
If you have any further questions, please feel free to call the Nurse Recruiters at (608) 261-0040.
Employment Questionnaire
________________________________________________ ________________________________________________ ________________________________________________ ________________________________________________ Email: ________________________________________________ ________________________________________________ ________________________________________________ Phone Number: ________________________________________________ ________________________________________________
Expected Graduation Date: _________________________________________________
Previous Work Experience:
____________________________________________________________________________________
____________________________________________________________________________________
Clinical Preference Area for Employment:
____________________________________________________________________________________

Shift Availability:
Weekdays: ____Days ____Evenings
Total number of hours available to work per week: __________ Desired start date: ______________ Please list past 3 clinical rotations, starting with your most current or most recent: Clinical date: _________ Site/Patient Pop:_______________ Instructor:_________ Clinical date: _________ Site/Patient Pop:_______________ Instructor:_________ Clinical date: _________ Site/Patient Pop:_______________ Instructor:_________ I hereby give the School of Nursing permission to release an evaluation of my performance to the University of Wisconsin Hospital and Clinics, Madison, Wisconsin. Signature: _____________________________________ Name: _______________________________________________ Date of Graduation:___________________ STUDENT NURSE ASSISTANT
REFERENCE RELEASE FORM
CLINICAL JUDGEMENT
Below Average ______
Comments:
___________________________________________________________________________________________
___________________________________________________________________________________________
CLINICAL PRACTICE
Below Average ______
Comments:
___________________________________________________________________________________________
___________________________________________________________________________________________
ATTENDANCE
Below Average ______
Comments:
___________________________________________________________________________________________
___________________________________________________________________________________________
COMMUNICATION SKILLS
Below Average ______
Comments:
___________________________________________________________________________________________
___________________________________________________________________________________________
INITIATIVE
Below Average ______
Comments:
___________________________________________________________________________________________
___________________________________________________________________________________________
TEAM BUILDING
Below Average ______
Comments:
___________________________________________________________________________________________
___________________________________________________________________________________________
Please use reverse side or add additional sheets if needed
Signature: _________________________________________________ Title:_____________________________
Place of Employment: _______________________________________ Phone:_____________________________
Relationship to Applicant:______________________________________________________Date:_____________

Reference information must be completed by your clinical instructor and returned to Nursing Recruitment.
References may be faxed to (608) 264-4640.
UNIVERSITY OF WISCONSIN HOSPITAL AND CLINICS PRE-EMPLOYMENT SKILL INVENTORY
OF STUDENT NURSE ASSISTANT
Please indicate your experience with the following: Please indicate your experience with the following: Please indicate your experience with the following: Proper Body Mechanics - Patient Positioning and

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