Human Resource Management

Student Worker/Intern Interest Form

Please complete the information requested below ONLY IF you have completed your on-line resume and read the provisions on the previous page.

asterisk required fields below with asterisk are REQUIRED

First Name

Last Name

E-mail Address

8 digit State Employee ID

(Only if a current state employee. If unknown, leave this field blank)

Identify the type(s) of position you are seeking

PAID Internship (academic credit)

UNPAID Internship (academic credit)

PAID Student Worker (no academic credit)

Where are you currently enrolled?

Name of school:

School city/state:

Academic program:
(major or discipline)

This is a ...

When is your anticipated date of completion for this program?

mm/dd/yyyy

Please note that your submitted data will be automatically deleted after your program completion date, as you will no longer be eligible for a student/intern position.

Where do you want to work?

Any/All of the below listed locations
St. Paul (Twin Cities Metro Area)
Bemidji (Northwestern District)
Duluth (Northeastern District)
Fergus Falls (West Central District)
Mankato (South Central District)
Marshall (Southwestern District)
Rochester (Southeastern District)
St. Cloud (Central District)

When are you available to work?

hours per week.

Available anytime during year OR
Available only certain months during year

If only available certain timeframe, please indicate:

FROM	mm/dd/yyyy
TO	mm/dd/yyyy

Are you fluent (writing & speaking) in any additional languages (including ASL)?

yes
no

If yes, please state language(s) and years experience

Identify your areas of interest within the Department of Health

Any/All/Doesn't Matter
Acute Disease Investigation
Administrative Support
Chronic Disease & Injury Prevention
Communications
Community & Family Health
Compliance Monitoring
Emergency Preparedness
Environmental Health
Facilities Management
Finance
Grant Writing
Health Data & Statistics

Health Education & Promotion
Human Resources
Infectious Disease Epidemiology
Information Systems & Technology
International Health
Laboratory
Library
Licensing & Certification
Managed Care
Policy & Legislation
Racial/Ethnic Health Disparities
Research & Planning
Rural/Underserved Urban Communities

Any additional comments you would like to submit (fields of study, availability, current employment, etc.)

1,000 character limit

Please type the letters/numbers you see here:

CUND9

into the text box below.

This is required to prevent automated abuse of this form .

After you submit your form, you will get a confirmation and links to further resources.

If you have further questions, please call 651-201-5770 or TTY 651-201-5797 or e-mail us at health.HR(at)state.mn.us

If you prefer to submit your materials via regular mail, please submit to:

Minnesota Department of Health
Human Resource Management
P.O. Box 64975
St. Paul, MN 55164-0975.