Empu Intern Application

Application for Internship

Empowered U Youth Movement
No question on this application is asked for the purpose of limiting of excluding any applicant’s consideration for volunteering because of his or her race, color, religion, sex, national origin, disability, or military status.
Full Name *

Prefix First Name Last Name
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Phone Number *

Area Code Phone Number
Date of Birth *

Month Day Year
Date
E-mail *
If your application is considered favorably, on what date can you begin Internship? *

Month Day Year
Date
What led you to consider volunteering for Empowered U? *
Have you previously been employed by us? *
If so, Job Title:
Are you 18 years of age or older *

OTHER INFORMATION
Please list and specialized skills, interests, and hobbies you feel may be beneficial to your work with Empowered U (for example: arts and crafts): *
Next of Kin *

First Name Last Name
Relationship *
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Do you own or operate an automobile that you intend to use to and from Empowered U *
Make and Model:
Year:
Color:
License No.:
How would you like to help? *

Administration Community Support Homeless and Hunger Events and Workshops Mentoring

Have you ever been convicted of a criminal offense other than a minor traffic offense? (The term conviction includes the imposition of a fine or sentence, a plea of guilty or “no contest.”) If so, please list all cases below. Give in each case (1) the date of the offense, (2) the nature of the offense, (3) the name and location of the court, and (4) the penalty imposed, if any, or other disposition of the case. Attach a separate sheet if necessary. Failure to provide complete information may result in disciplinary action up to and including termination of employment. *
I understand that once I begin an Internship and Empowered U and I am convicted of any unlawful act, I am to report to my Department Supervisor within 24 hours, giving the following information: (1) the date of the offense, (2) the nature of the offense, (3) the name and location of the court, and (4) the penalty imposed, if any, or other disposition of the case. Failure to follow these instructions may result in disciplinary action up to and including termination of services. I understand that Empowered U may conduct a South Carolina Law Enforcement Division (SLED) background check and an investigation of my driving record. I authorize SLED, the South Carolina Department of Public Safety, or any other city, county, state, or federal agency to furnish any information on file under the name on this form, and I release all persons from liability as a result of furnishing such information. I understand that any false answers or statements made by me on this form may be sufficient cause for dismissal.

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IMPORTANT - PLEASE READ BEFORE SIGNING
I understand and agree that I shall be subject to immediate termination if it shall be determined that my answers are untrue or that I have failed to disclose a material fact. I understand and agree that the fact that the employer has made or has not made an investigation or the fact that I have performed work satisfactorily for any period of time prior to this determination, shall not constitute a waiver, abandonment, or bar of the right of the employer to take such disciplinary action. I authorize the use of any information in this application to enable the employer to verify my statements, and I authorize past employers, all references, and any other persons to answer all questions asked by the employer concerning my ability, character, reputation, and previous employment record. I further agree, if employed, that I am to work faithfully and diligently, to be careful and avoid accidents, to come to work promptly, and I am not to be absent for any reason without notice to my supervisor. If employed, I agree to abide by all present and subsequently issued personnel policies and rules of the employer. I agree that I am employed at-will and that I may be dismissed by the employer at any time and for any reason at the discretion of the employer. The personnel policies of the employer are not a contractof employment. No one at Empowered U, with the exception of the Director, has the authority to enter into a written contract of employment and such contract must be written and signed by the Director. All volunteers of Empowered U are volunteers at will who may quit at any time for any reason and who may be terminated at any time and for any or no reason.

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Application for Internship