Internship/Volunteer Template

Please check the region you are interested in:*

Please check the program(s) you are interested in:*

If you desire an internship, what type of internship are you interested in?

Availability (select all that apply)*

How did you hear of Olive Crest? (please be specific):

Please tell us why you are interested in volunteering/interning with Olive Crest. If you are applying for a specific program or department please include specific information pertinent to that role.

When are the best times to schedule an interview?

Name*

First NameMiddle NameLast Name

Address*

Street Address

Street Address Line 2

CityState

Zip Code

Phone Number*

Area CodePhone Number

Email*

example@example.com

Date of Birth

What languages do you speak, read, or write fluently?

Do you have a valid driver's license?

YesNo

Driver's License State

Do you have any driving violations on your DMV record within the last 3 years?

YesNo

Note: If you drive clients, you will be required to maintain an acceptable driving record and automobile insurance that meets minimum state requirements.

Are there any accommodations you would require or any health conditions that may affect your ability to volunteer/intern with us?*

YesNo

If yes, please explain:

If you desire to be a mentor, please answer the following question. Are you currently in therapy? (You may be required to submit a therapy referral.)

YesNo

A. Have you ever been convicted of a crime? (Criminal record clearance may be required)*

YesNo

If your answer to A above is YES, please provide details for each incident (Date, Location, Nature and Disposition):

Do you have a High School Diploma or Equivalent?

Yes

UNDERGRADUATE AND GRADUATE LEVEL EDUCATION

College

Name of University, College or Business School Attended

Units Completed / In Progress

Graduated?

Yes

Major / Degree / Course

Dates Attended / Completed

College

Name of University, College or Business School Attended

Units Completed / In Progress

Graduated?

Yes

Major / Degree / Course

Dates Attended / Completed

Other educational, employment, and life experiences that contribute to your work as a volunteer/intern:

State any additional information you feel may be helpful to us in considering your application:

Please fill out all information as completely as possible, starting with your present or most recent employment/volunteer experience. You may also include any applicable volunteer experience or military service assignments.

Employer / Organization

Position

Hours per week

Address (Street, City, State, Zip)

Date

Name of Supervisor

Supervisor Email Address

Telephone

Describe your work

Reason for leaving

Employer / Organization

Position

Hours per week

Address (Street, City, State, Zip)

Date

Name of Supervisor

Supervisor Email Address

Telephone

Describe your work

Reason for leaving

Please list any additional volunteer activities relevant to becoming an intern/volunteer with Olive Crest.

List three people who are not related to you and who can give information about your background, character, abilities, etc., from a professional perspective.

Examples may include (but not limited to): current/previous professors, academic advisors, co-workers, members from group/volunteer organizations. Please provide complete, accurate, up to date information.

Name

Relationship

Email

example@example.com

Phone Number

Area CodePhone Number

Name

Relationship

Email

example@example.com

Phone Number

Area CodePhone Number

Name

Relationship

Email

example@example.com

Phone Number

Area CodePhone Number

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I understand my responsibility to maintain confidentiality.

Confidential information is not to be disclosed to anyone outside of Olive Crest (including other clients) and includes:

· Information about (including names of) past or present Olive Crest clients

· Photographs of past or present Olive Crest clients

· Addresses and telephone numbers of residential therapeutic programs,

transitional-aged youth programs, and resource homes

· Information about past or present Olive Crest constituents, or Olive Crest

business activities

· Any information released to the press or any news media unless authorized

by Olive Crest's Chief Executive Officer

If I witness, become aware of, or reasonably suspect that a child has been the victim of abuse, I will report such to an Olive Crest director.

I understand that Olive Crest accepts no responsibility for any personal items brought by me to any Olive Crest site, and assume full responsibility for my personal items.

I hereby acknowledge that I will comply with Olive Crest policies throughout the duration, as well as after my time of volunteerism.

By clicking submit I certify that the answers given herein are true and complete to the best of my knowledge.

Applicant's Signature*

VOLUNTEER/INTERN APPLICATION

PERSONAL INFORMATION

EDUCATION

EMPLOYMENT / VOLUNTEER EXPERIENCE

PROFESSIONAL REFERENCES

COVER LETTER & RESUME (OPTIONAL)

POLICY AND CONFIDENTIALITY STATEMENTS/APPLICANTS STATEMENT