Internship Application

PERSONAL INFORMATION

Name	Birthdate	School Year	Social Security Number

Address	City	State	Zip Code

Home Telephone	Cell Phone	Email

AVAILABILITY

Start:	End:	Available Work Days	Interview Availability
		ctrl+shift for multiple selections

EMERGENCY CONTACT INFORMATION

Contact #1 Name	Phone	Relationship
Contact #2 Name	Phone	Relationship
Contact #3 Name	Phone	Relationship

CAREER & EDUCATIONAL OBJECTIVES

What interested you to apply for an internship at Mechanical Rubber?

What are your academic and/or educational goals for the future?

Please list, in order of preference, occupations you want to pursue as future career goals.

EDUCATION

College

Year graduated (or anticipated)

What are your two favorite subjects in school? Explain skills learned in each.

What extracurricular activities or clubs are you involved with?

Special Skills / Expertise

JOB SKILLS

Identify your strongest work-related skills and explain why they are your strongest.

Give examples of teamwork skills you use on a regular basis.

Describe four personal management skills and give an example of how you use each skill in your daily life.

REFERENCES

Name	Address	Phone	Business	Years Known

Comments

Upload Resume if available (not required)

AUTHORIZATION

"I, the applicant, certify that the information given in and with this application is true and complete to the best of my knowledge and that it may be viewed by employers for the purpose of determining potential placement.
"I agree to attend any safety courses or sessions required for individual programs or departments. I understand that my application does not guarantee employment."

Date:		Signature:
			You will be required to sign this form in person, should you be called in for an interview.

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