I agree that by signing this document, all information contained within is truthful and accurate. I further understand that failure to perform any/all of these essential skills safely, and within a timely fashion, will prevent me from progressing to the Internship portion of the Phlebotomy Certificate. Inability to perform any skill required of the job of Phlebotomist in a safe manner as determined by my PHBC 110R Instructor may prevent me from continuing on to the Phlebotomy Internship (PHBC 190R) per the RVCC Work Based Learning Policy found in the student handbook.
Additionally, students in programs that require successful completion of a clinical placement or internship should be aware that clinical sites are not necessarily required to recognize accommodations contained within an Individual Reasonable Accommodation Plan (IRAP) issued by River Valley Community College (“RVCC”) designed for use in classroom setting pursuant to the Americans with Disabilities Act. Please be aware that clinical sites may need to adapt any accommodation request you make in a manner that does not create an undue hardship for them and does not require them to alter the essential functions of the internship expectations. You are encouraged to discuss the accommodation process with both your site
supervision and your RVCC faculty.
By signing below, I attest that I understand the following:
• In order to be eligible for the Phlebotomy internship, I will need to provide a Criminal Background Check and drug test, no earlier than six weeks before my internship starts, to program faculty and/or to my internship site. Program faculty will explain this process during PHBC 110R.
• That a positive record on either the Criminal Background Check (misdemeanor or felony) or drug test will limit, and may prevent me, from being assigned an internship and therefore I will be ineligible to complete the program.
• That a positive record on either the Criminal Background Check (misdemeanor or felony) or drug test will limit, and may prevent me, from being eligible for employment as a Phlebotomist; even if I am allowed to complete the internship.
• I will direct any question about my specific circumstances related to both drug testing and Criminal Background Checks to my Academic Advisor, Nancy Eckert, firstname.lastname@example.org