Internship Application

Applicant's Information

Applicant's Name: *

Current Address: *

Permanent Address: *

Email Address: *

WWW Address:

Home Phone Number:

Mobile Phone Number:

Work Phone Number:

Gender:

Age:

Ethnicity:

How did you hear about our Internship/Volunteer Opportunity?:

Time Frame or Semester: *

Will you receive college credit and a grade?: *

Do you have reliable transportation? : *

What form of transportation?: *

Education

Education: High School Diploma: *

Education: College Experience: *

None

1-2 years

3-4 years

Education: Degree: *

Education: Major/Minor: *

Working Experience

Prior Work Experience

Where:

Time Frame - From:

Time Frame - To:

Type of Work:

Volunteer / Paid:

Prior Work Experience 2

Where:

Time Frame - From:

Time Frame - To:

Type of Work:

Volunteer / Paid:

Prior Work Experience 3

Where:

Time Frame - From:

Time Frame - To:

Type of Work:

Volunteer / Paid:

References

Please list references (not related to you) #1:

Please list references (not related to you) #2:

Please list references (not related to you) #3:

Below is a list of available schedules. You may be able to work a variety of hours. Please include any special scheduling reques

Mornings: *

Midday: *

Afternoons: *

All Days: *

Special Scheduling Requests:

Upload: Cover Letter:

Upload: Resume:

Certification/Consent: *

I certify that all of the information submitted in this application is true to the best of my knowledge and belief. I understand that any significant misstatement in, or omission of, this application may be the cause for denial of selection of or dismissal from an internship position. I authorize DA to consult with persons who have may have information on my professional competence, character and ethical qualifications. I release from liability all individuals and organizations who provide information to DA in good faith and without malice concerning my qualifications.

Confidentiality Agreement: *

I understand and agree that as an intern for DA I have access to sensitive information of a confidential nature and agree to maintain the confidentiality of DA’s information including its’ business associates, donors and prospects. I understand that a breach of this agreement will be grounds for termination. DA is an “at will” employer, therefore I understand the relationship between DA and myself is voluntary and may be terminated by either party without cause or notice at any time.

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