Kyle Brown Performance Internship Application
90hr or 450hr
Applicant Information
Name
First Name
Last Name
Age
Gender
Male
Female
Phone Number
Please enter a valid phone number.
Email
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Start Date of Internship (Availability)
-
Month
-
Day
Year
Date
End Date of Internship (Projected)
-
Month
-
Day
Year
Date
Are there any scheduling conflicts that may occur during your internship?
Yes
No
If yes, please indicate the reason why:
What is your reason for choosing KBP as your internship site?
What do you expect from us during your internship here at KBP?
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 attendend
Special honors/Achievements
Are you currently CPR/AED certified?
Yes
No
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Do you currently hold any field related certifications?
Yes
No
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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.
Email
example@example.com
Have you been convicted of a criminal offense?
Yes
No
Have you completed other internship programs before?
Yes
No
If yes, what is the company/organization name?
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.
Applicant's Signature
Date Signed
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Month
-
Day
Year
Date
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