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*
Date of Birth*

MonthDayYear
Are you currently employed?*

Full TimePart TimeN/A
Occupation:   Short Answer
Length of employment:   In Months or Years
Supervisor:   First and Last Name
Acknowledgement*

I understand that by filling out this form I give consent for a required background check, and for photo and video permission to Breckenridge Village of Tyler.
Emergency Contact Information
Name of Emergency Contact*

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

YesNoOther
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*

Resident ContactNon-resident ContactSpecial Projects
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?*

YesNo
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.
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Breckenridge Village Internship Application

Personal Information

Emergency Contact Information

Internship Specific Questions

Internship policies