Human Resources | Collegiate Internship Application

Collegiate Internship Application

Human Resources Department
PERSONAL DATA

First NameMiddle NameLast Name
Present Mailing Address
Street or PO Box City State and Zip Code
Home/School Phone
Format: (000) 000-0000.
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email Address
example@example.com
Are you authorized to work in the United States of America?
Do you have a valid driver's license?
Divers license number
Issuing State
Have you ever been convicted of a felony?
Have you ever been convicted of a misdemeanor?
If yes, state type of offense, date, location and explain:
A conviction (felony or misdemeanor) does not automatically eliminate you from employment consideration. However, failure to disclose criminal convictions may result in disqualification from internship employment consideration or may result in dismissal if you have been hired. The nature of the offense, when the offense occurred, type of internship you are applying for and your truthfulness may be taken into consideration.
EDUCATIONAL HISTORY
Undergraduate School
Classification
Graduation Date

MonthDayYear
Date
Major
Minor
GPA
Are you currently enrolled?
Graduate School
Program of Study
GPA
List name, address and telephone number of University Internship Coordinator/Advisor (if applicable):
Name
Telephone
Format: (000) 000-0000.
Address
RELATED EMPLOYMENT HISTORY
Job Title
Employer
Date Emoployed
From
To
Supervisors Name
Address
Supervisors Title
Telephone Number
Format: (000) 000-0000.
Description of Duties
Reason for Leaving
Job Title
Employer
Date Employed
From
To
Supervisors Name
Address
Supervisors Title
Telephone Number
Format: (000) 000-0000.
Description of Duties
Reason for Leaving
GOALS THROUGH INTERNING
RELEVANT COURSE WORK, COMPUTER, SPECIAL SKILLS, CERTIFICATTES, OR LICENSES
TIMES AVAILABLE
Number of hours per week:
Check All Days Available:
Availability:
EXTRACURRICULAR ACTIVITIES AND VOLUNTEER EXPERIENCE if applicable
AREAS/POSITIONS OF INTERESTS
College Transcripts

Unofficial transcripts may be accepted for initial consideration.
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Recommendation Letter

From faculty member or past employer.
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Professional Resume

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READ CAREFULLY BEFORE SIGNING

Certification of Application Information

I certify that the information provided to the previous questions is true and correct, and that no attempt has been made to conceal pertinent information. I understand that if any information given by me in this application is found to be false or misleading, I will be subject to dismissal at any time, and will agree to hold Glynn County Board of Commissioners, its officials and employees harmless in that event.

Authorization to Obtain Information

I authorize Glynn County Board of Commissioners to perform a background investigation in connection with my application for employment. This investigation may include information as to my criminal history, credit report, schools attended, Division of Motor Vehicles records, present/past employers, professional references, personal references, military records and other appropriate sources.

I authorize release of any information that Glynn County Board of Commissioners may request from the above sources. All information received by the County will only be used by the County in accordance with applicable laws.

I understand that should I be offered employment, it will be contingent upon a successful drug test and/or criminal background investigation.
Applicant Signature
Date

MonthDayYear
Date
GLYNN COUNTY, GEORGIA

An Equal Opportunity Employer Committed to Workforce Diversity
Should be Empty:

Collegiate Internship Application

EDUCATIONAL HISTORY

RELATED EMPLOYMENT HISTORY

TIMES AVAILABLE

READ CAREFULLY BEFORE SIGNING

GLYNN COUNTY, GEORGIA