Junior Internship Application - Lake Wales Care Center

Junior & On-The-Job Internship Application

"*" indicates required fields

Applicant Information

Name*

First Last

Email*

Phone*

Birth Date*

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Local Church Affiliation*

Please list N/A if none

How did you hear about our internship program?*

Experience, Education and Skills

Employment Status*

Full-Time

Part-Time

Not Employed

Current or most recent paid position held

School Attending: (Current Students - High School & College)*

If not in school (college/high school), please put N/A.

Grade Level*

Freshmen

Sophomore

Junior

Senior

College

Do you speak any other languages? If yes, which languages do you speak?*

What are your hobbies/interests?*

Emergency Contact Information

Parent Name (if under 18):

Emergency Contact Name:*

Emergency Contact Relation to Volunteer Applicant:*

Emergency Contact Phone Number:*

Personal Interests

Why are you interested in an internship with our organization?*

What specific experience would you like to gain through this internship?*

Describe your long-term career goals*

Please explain your faith journey. Include a personal testimony and how it has impacted your relationship with Christ*

Professional References

Please include three professional references. Clearly state the name of the reference, their relationship to you, and their email and/or phone number.

Disclaimer and Signature

Have you ever been convicted of a crime?*

Yes

No

I certify that I understand the Junior Internship is a drug and alcohol-free program. While in the program, I commit to abstaining from such practices.

Yes

No

I certify that my answers are true and complete to the best of my knowledge. If this application leads to an internship assignment, I understand that false information in my application may result in my release from the Junior Internship program.

Yes

No

Signature and Date - Please type your full name and today's date