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STUDENT APPLICATION FOR INTERNSHIP
Date
Last Name
First Name
Middle Name
Citizenship Status (Check One)
 U.S.    Permanent Resident    Student Visa
Home Address Line 1
Home Address Line 2
City
State/Province
Postal Code
 
Phone Type
Phone Number
Extension
Email
School Address (Number & Street, Apartment or Box No.)
City
State/Province
  		Postal Code
School Telephone
 
Name of Parent, Spouse or Guardian
Guardian Address
City
State/Province
Postal Code

 

EDUCATION INFORMATION
Name of Academic Institution
Year in School
Major
Minor
Grade Point Average
Expected Graduation Date

 

EMPLOYMENT RECORD
Please list all employment experience for the past seven years, starting with the most recent or present employer, including any US Military Service or verified work performed on a volunteer basis.
Employer
Description of Duties
From
To

 

ADDITIONAL INFORMATION
Skills
Computer Programming
Drafting or Mechanical Drawing
Yes   No
Other Skills/Abilities/Interests
Languages (Written/Spoken/Read)

 

INTERNSHIP INFORMATION
When are you available to start a work-study/internship?
Approximate length of internship (desired # of weeks)
Approximate hours per week
Geographic limitations/preferences for internship
What are your objectives for participating in an internship program?
What kinds of work would you like to do during your internship?
Internship Preference
Specialist - Area of Interest   Generalist
If Special Area
If a stipend is not offered, would you be able to accept an internship on a volunteer basis?
Yes   No
What, if any, limitations do you have that may have a bearing on your placement?
Do you have a driver's license and use of a car?
Yes   No   License Only
Will academic credit be earned through this internship?
 Yes    No
If yes, please provide professor name, course name, total credits earned:

I certify that all of the above information is true and complete, and I understand that any falsification or omission of information may disqualify me from further consideration for employment or, if hired, may result in termination regardless of the time elapsed before discovery.

Note: An offer of employment is conditioned upon complying with Company’s requirements including, but not limited to, signing a consent to conduct a background investigation.

I AGREE, AND IT IS MY INTENT, TO SIGN THIS EMPLOYMENT APPLICATION BY CHECKING THE "I ACCEPT" BOX BELOW AND BY ELECTRONICALLY SUBMITTING THIS DOCUMENT TO COMPANY, I UNDERSTAND THAT MY SIGNING AND SUBMITTING THIS DOCUMENT IN THIS FASHION IS THE LEGAL EQUIVALENT OF HAVING PLACED MY HANDWRITTEN SIGNATURE ON THE SUBMITTED DOCUMENT.

 Signature
(checking the box above is equivalent to a handwritten signature)