Breckenridge Village Internship Application

Breckenridge Village Internship Application

Breckenridge Village is a Christ-centered community of adults with mild to moderate intellectual and developmental disabilities. Breckenridge Village is dedicated to empowering and assisting residents and participants in developing spiritually, socially, mentally, emotionally, and physically in a compassionate and safe environment.
We are looking for quality candidates who are interested in working with our amazing community through a paid internship program. Part-time and full-time positions available in the following areas: Kinesiology, health science, computer sciences, and many more.

Please complete the form below to apply for a position with us.
Personal Information
Name

First NameMiddle InitialLast Name
Social Security No
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email
example@example.com
Phone Number
Format: (000) 000-0000.
Date of Birth

MonthDayYear
Are you currently employed?
Occupation:   Short Answer
Length of employment:   In Months or Years
Supervisor:   First and Last Name
Acknowledgement
Emergency Contact Information
Name of Emergency Contact

First NameLast Name
Phone Number of Emergency Contact
Please enter a valid phone number.Format: (000) 000-0000.
Relationship to you
Internship Specific Questions
High School Information
College or University Information
Are you volunteering for class credit?

Other
Please list previous experience with persons with an intellectual or developmental disability (IDD), previous volunteer experience, previous applicable work experience and/or affiliations with community organizations or clubs.
Do you have any relatives who have worked or currently work at Breckenridge VT? If yes, please provide their name
Please list two professional or personal references (not related to you). Include Name, Email, and Phone number.
Please list any special skills, trainings or abilities (including any additional languages that you may speak).
Preference of type of Internship work
How much time can you commit to doing an internship?
When are you available? (Please indicate specific times)
Have you ever been convicted by federal, state, or any other law enforcement authorities for any violation ofany federal, state, county or municipal law, regulation or ordinance?
If yes, please describe.
(All applicants will be subject to a criminal history record check through the Department of Public Safety)
Internship policies
Interns must always abide by the following policies. Failure to comply will result in immediate dismissal from Breckenridge Village property and internship program.

1. Interns are not permitted to take photos, videos, or audio recordings on campus at all, or off campus if Breckenridge Village individuals are present. If your group would like a photo, please contact a BVT staff member to request this and we would be happy to help accommodate.

2. Interns must stay in the area designated by staff.

3. Interns must always wear an intern lanyard.

4. Foul or demeaning language, alcohol, drugs, and weapons are strongly prohibited.

By signing below, I certify that all information on this application is correct. I have not given any false statements concerning my qualification requirements. I have read and agree with the above statements. I am capable of performing this internship.
Signature
Date Signed

MonthDayYear
Date
Should be Empty:

Breckenridge Village Internship Application

Personal Information

Emergency Contact Information

Internship Specific Questions

Internship policies