Career Internship Program Application




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Home > Departments > Career Internship Program > Application	Print View

Career Internship Program Application

DIRECTIONS: You must complete this application in one sitting. You must provide answers for all the blanks indicated with (red) type.

Student Number

Advisory Room #

Last Name

First Name

Gender

M
F

Grade
12
11
10
9

Home Address

City

Zipcode

Contact (Home) Phone number

Your cell Phone Number

Your E-mail Address

Please complete as follows: Mr. James Jones or Ms. Cindy Jones

Parent(s) or Guardian

Parent/Guardian Work Phone

Do you live at Home?

Yes
No

Whom do you live with?

Both Parents
Father
Mother
Guardian
Other

Do you have a driver's license?

Yes No

Do you have the use of a motor vehicle each day?

Yes No

Have you passed the BST-Reading?

Yes No

Have you passed the BST-Writing?

Yes No

Have you passed the BST-Math?

Yes No

Do you need to make up any missed or failed classes?

Yes No

Career Plan: List your career (job) plans after high school. What kind of work would you like to do for the rest of your life? Note: Going to college or a technical school is NOT a career choice.

1st Choice

2nd Choice

3rd Choice

4th Choice

EDUCATION PLAN; Most careers now involve further training and eduction. If you intend to continue your education beyond high school please indicate below.

Education Plan

4 year College or University
2 year Community College
Vocational or Technical College
Enter the Military Service
Enter the Job market
Other

EXPERIENCE INVENTORY: to help me better place you in an internship experience that matches your talents and interests, please complete the following.

List any special talents, skills, or experiences.

List any special equipment that you have experience operating.

EMPLOYMENT EXPERIENCE

Are you presently employed?

Yes No

Company Name

Company address

City

Zip

Supervisor

Wage per hour

Job title

Please answer the following questions that relate to your attendance and tardiness.

How many times have you been absent from school this trimester?

Never
1 to 2 times
3 to 4 times
5 to 7 times
8 to 10 times
more than 10 times

How many times have you been tardy to school this trimester?

Never
1 to 2 times
3 to 4 times
5 to 7 times
8 to 10 times
more than 10 times

How many times have you been absent from your period one class?

Never
1 to 2 times
3 to 4 times
5 to 7 times
8 to 10 times
more than 10 times

[ Finish ]

Steps:

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