Lancaster County Emergency Management Agency Internship Opportunity Application

Lancaster Emergency Management Agency Internship Application
Lancaster County Emergency Management Agency Internship Opportunity Application
The collection of information may be used to obtain information from organizations and individuals pertaining to your character, education and current and/or prior employment as may be relevant and necessary to determine your fitness and suitability for acceptance into the Lancaster County Emergency Management Agency Internship opportunity.
Personal Information
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email*
example@example.com
Educational Background and Goals

Please provide information regarding your education, academic institution, and your internship learning goals. Please list the school, College, or University where you are currently enrolled.
Academic Institution *
List your school, college or university where you are currently enrolled.
Academic Program*
Please list what academic program you are enrolled in (Emergency Management, Public Health, Data Science, etc.)
Please select your Academic Program Level*

Associates DegreeBachelors DegreeMasters DegreeDoctorateCertificate ProgramOther
Academic Program Contact*
Please provide the full name, phone number and email address of your academic program contact.
Learning Goals
Please discuss your learning goals/objectives. Is there a specific area of focus you'd like to emphasize if selected for an internship?
Do you have a project proposal?*

YesNo
If you answered yes, please provide your proposed project information.
Proposed Project File Upload

Cancelof
Please select your top domain interest. You may select more than one.*

Operational ReadinessTraining and ExercisePlanning and AdministrationCommunity Resilience and EngagementHealth and Medical PreparednessData ScienceOther
Prior Emergency Management Experience and Training
Please list prior emergency management training or experience.
Other Relevant Skills
Please list any specialized skills or experience you consider to be relevant to your internship experience. This may include software expertise, medical or veterinary skills, administrative skills or background
References

Please list three professional or academic references below.
Reference 1*
Please provide the full name, phone number and email address of your reference.
Reference 2*
Please provide the full name, phone number and email address of your reference.
Reference 3*
Please provide the full name, phone number and email address of your reference.
Please upload any supporting documents such as a resume, cover letter/interest statement, and/or PA State Police background check.

Please upload at most one file Kindly attach the aforementioned documents along with the survey Please upload a copy of your PA State Police Criminal Background Check.
Attachments

Please upload supporting documents.
Resume and Cover Letter*

Cancelof
Background Check *

Please upload a copy of your PA State Police Criminal Background Check. Visit https://epatch.pa.gov/home
Cancelof
By typing my full name above, it constitutes consent and authorization to the disclosure or furnishing of any relevant and necessary information or records to any duly authorized official acting on behalf of the County of Lancaster or the Lancaster County Emergency Management Agency for any person, corporation, agency, or association concerning my character, employment, education or military service as may be relevant and necessary for a determination of my suitability for volunteer status and may include reference checks, ACT 34, Childline, FBI, and criminal background investigation. It is in my interest to permit such investigations to take place by Lancaster County Officials and, therefore, in consideration of my desire to have all of the material considered, I hereby authorize Lancaster County Officials to make such inquiries. I certify that all information provided in this document and any accompanying documents is accurate, correct and complete. I understand that falsification or misrepresentation or omission of any facts in said documents will be cause for denial of acceptance into the LEMA Internship opportunity. The reverse of this form lists reasons for which acceptance may be denied. If, after being accepted into the program, I subsequently become subject to anything on this list, I will immediately notify the County Emergency Management Director. It is understood that I shall make no claim against the person or persons furnishing information and shall make no claim against any firm, organizations, agency, or Lancaster County for providing or reasonably using any information. The release of any information desired is respectfully requested and authorized with my full understanding and endorsement.
To consent, please type your full name below*
Please type your full name to consent. If you do not consent, please exit the survey now.
Thank you for applying for an internship opportunity at Lancaster County Emergency Management Agency. We will contact you shortly regarding your request. You will be redirected to the PA State Police ePatch website. If you have not already provided a current (within 1 year) criminal background check with this application, you can apply for one here. Once you've received your results, forward them to: info@lancema.us to accompany your application.

Submit your survey. Thank you for completing this survey.
Should be Empty: