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*One application must be completed for each requested clinical rotation.
My typed name above shall constitute an electronic signature and have the same force and effect as my written signature.
I hereby authorize Lancaster General Health and their representatives to consult with administrators/ supervisors and academic institutions with which I have been associated and with others who may have information bearing on my professional competence. I hereby release from any liability any and all individuals and organizations listed above who provide information to the Lancaster General Health and any member affiliate in good faith concerning my professional competence, educational credentials, ethics, character and other qualifications and I hereby consent to the release of such information. With the submission of this application I certify that all statements are true and correct to the best of my knowledge and belief. Any misrepresentation or omissions on this application may be sufficient cause for rejection of the application or dismissal from an internship. To commence a clinical rotation the following must be completed:
2. Letter of Academic Standing
3. Criminal background check
4. Child Abuse Clearances
5. Proof of Immunizations to include flu vaccine
6. Proof of Liability Insurance
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