Intern Application

Name*
First Last
Personal Email Address*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
School Information
School Attending*
Degree Program*
Year of Study*
Total Hours Required*
School Contact
Name*
Phone
Email
Requested Start Date
Please note the date you would like to start the internship.
Date
MM slash DD slash YYYY

Employment or Volunteer History
Company 1 Name
Phone
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Employed (state month and year)
Supervisor
Job Title
Summary of Duties
Reason for Leaving
Company 2 Name
Phone
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Employed (state month and year)
Supervisor
Job Title
Summary of Duties
Reason for Leaving
Company 3 Name
Phone
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Employed (state month and year)
Supervisor
Job Title
Summary of Duties
Reason for Leaving

Please describe any specialized training (workshops, seminars, etc.), skills, languages spoken, etc.
Please list any pertinent professional / trade associations to which you belong.
Organization names that indicate gender, race, religion or other classification may be omitted, and, if included, will not be used to discriminate.
Specialized Skills
Please indicate computer skills you possess including software with which you are familiar. For Secretarial/Administrative Assistant: how many words per minute can you type?

Resume Upload
Please upload your resume.
Accepted file types: pdf, doc, docx, Max. file size: 2 MB.
Authorize and Submit
I authorize InterCommunity, Inc. and its representatives to contact my prior employers and all others for the purpose of verification of the information I have supplied and release same from any liability resulting from the information released. I certify, under penalty of perjury, that all of the above information is true and complete, and I understand that any falsification or omission of information may result in denial of placement or, if hired, may result in termination regardless of the time lapse before discovery. Inserting my name below is evidence that I have read the above statements and agree that they are true and accurate to the best of my knowledge.
Electronic Signature*
Date*
Confirm Signature*
- I understand that checking this box constitutes a legal signature confirming that I acknowledge and agree to the above Terms.
Number

School Information