Student Intern Application
Applicant Information
Name
*
First Name
Last Name
Age
*
Gender
*
Male
Female
Other
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
Twitter Handle:
Facebook Url:
Instagram Handle:
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Position
*
Social Media & Marketing Intern
Mentor Recruitment & Community Outreach Intern
Youth Education & Scholarship Intern
Fundraiser & Development Intern
Program Operations Intern
Other
Start Date of Internship (Availability)
*
-
Month
-
Day
Year
Date
End Date of Internship (Projected)
*
-
Month
-
Day
Year
Date
How were you referred to us?
*
Instagram
Twitter
Facebook
Other
Upload Resume (if applicable)
*
Browse Files
Drag and drop files here
Choose a file
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Upload Picture
*
Browse Files
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What is your reason for applying for internship with B.O.S.S Mentoring Inc.?
*
What do you expect from us during your internship here?
*
What are your goals and ambitions?
*
What are things you want to learn during your internship?
*
What are your related skills that can be used for the internship?
*
Education Information (Last School)
School Name
*
Grade Level/Degree
*
Years attended
*
Special honors/Achievements
Employment History (Last company)
Company Name
*
Position/Title
*
Duration (number of months)
*
What is your role and responsibilities in that company?
*
References
Name
*
First Name
Last Name
Relationship
*
Company Name
*
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
Name
*
First Name
Last Name
Relationship
*
Company Name
*
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
Have you been convicted of a criminal offense?
*
Yes
No
Have you joined other internship program before?
*
Yes
No
If yes, what is the company/organization name?
*
Forms
Review all documents listed below
Please review document: Intern Description & Program Standards
Intern Name
First Name
Last Name
Intern Signature
*
Date
*
-
Month
-
Day
Year
Date
Please review document: Intern Agreement
Intern Name
*
First Name
Last Name
Intern Signature
*
Date
*
-
Month
-
Day
Year
Date
Parent/ Guardian Consent Form: To be completed by parent/ guardian of Interns in High School
Part I: Permission to Participate
High School Intern Only
Parent/ Guardian Name
*
First Name
Last Name
Parent/ Guardian Signature
*
Date
*
-
Month
-
Day
Year
Date
Part II: Emergency Authorization
In case of emergency contact : To be completed by High School/ College/ Graduate Intern
Name
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Intern Name or Parent/ Guardian Name : (High School Intern)
*
First Name
Last Name
Intern Signature or Parent/ Guardian Signature ( High School Intern)
*
Date
*
-
Month
-
Day
Year
Date
Part III: Liability
To be completed by High School/ College/ Graduate Intern
Intern Name or Parent/ Guardian Name ( High School Intern)
*
First Name
Last Name
Intern Signature or Parent/ Guardian Signature ( High School Intern)
*
Date
*
-
Month
-
Day
Year
Date
Please review document: Photo Release Form
Intern Name or Parent/ Guardian Name ( High School Intern)
*
First Name
Last Name
Intern Signature or Parent/ Guardian Signature ( High School Intern)
*
Date
*
-
Month
-
Day
Year
Date
Please review document: Conflict of Interest
Intern Name
*
First Name
Last Name
Intern Signature
*
Date
*
-
Month
-
Day
Year
Date
Please review document: Whistleblower Policy
Intern Name
*
First Name
Last Name
Intern Signature
*
Date
*
-
Month
-
Day
Year
Date
Background Check: To be completed by College/ Graduate School Intern
Use the following codes when scheduling background check appointment Service Code: 2FIJ3Y Contributor Case Number: D19003
Scan Code on cellular device to access form to schedule Background Check for College/ Graduate School Intern
Use the following codes when scheduling background check appointment Service Code: 2FIJ3Y Contributor Case Number: D19003
Acknowledgment
I hereby certify that all information I provided in this document is accurate and true to the best of my knowledge. I confirm that I have read and understood the reason why the Personal Information Collection Statement is required. I understand that data collected from this form will be used for recruitment and evaluation purposes only. All data will be strictly confidential.
Intern Signature or Parent/ Guardian Signature ( High School Intern)
*
Date Signed
*
-
Month
-
Day
Year
Date
Submit
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