Volunteer Internship Application

List the specific internship position you are applying for OR area(s) of interest:

Personal Information

Name*

First Middle Initial Last

Address*

Street Address Address Line 2 City State ZIP Code

Phone*

Email*

Are you currently authorized to work in the United States?*

Proof of such is required upon employment.

Yes
No

Academic Information

Name of College or University where you are currently enrolled:*

Location of College or University*

City, state

Major(s)*

Current Academic Standing*

Are you seeking academic credit for this experience?*

What class or program of study is this connected with?

What are your learning objectives for this experience?

What is the time commitment required by your class or program of study for an internship?

List the number of hours per week or the number of hours per semester required.

Academic Contact Name*

Who is the academic contact for your internship?

Academic Contact's Position

Academic Contact's Email and/or Phone*

What semester are you applying for?*

Name of High School*

High School Location

City, state

Work Experience

Begin with the most recent job. Also include longest or most important jobs held.

Employer Name*

Employer Address*

Street Address Address Line 2 City State ZIP Code

Employer Contact Name*

Employer Contact Email

Employer Phone

May we contact this employer?*

Yes
No

Employment Dates

Employment Start Date*

Employment End Date*

Job Title*

Job Duties*

Job 2

Employer Name 2

Employer 2 Address

Street Address Address Line 2 City State ZIP Code

Employer 2 Contact Name

Employer 2 Contact Email

Employer 2 Phone

May we contact this employer?

Yes
No

Employment Dates

Employment Start Date

Employment End Date

Job 2 Title

Job 2 Duties

Job 3

Employer Name 3

Employer 3 Address

Street Address Address Line 2 City State ZIP Code

Employer 3 Contact Name

Employer 3 Contact Email

Employer 3 Phone

May we contact this employer?

Yes
No

Employment Dates

Employment Start Date

Employment End Date

Job 3 Title

Job 3 Duties

References

List 3 people that we may contact about your application (At least 2 should be work-related; 1 may be personal). No written reference letters are required.

Reference 1 Name*

Reference 1 Relationship*

Reference 1 Email or Phone Number*

Reference #2

Reference 2 Name

Reference 2 Relationship

Reference 2 Email or Phone Number

Reference #3

Reference 3 Name

Reference 3 Relationship

Reference 3 Email or Phone Number

Other Information

List any specific classes, skills, or training; knowledge of equipment, tools, or machinery; volunteer work, internships, or other experiences that would strengthen or support your application.

How will an internship at Living History Farms help you achieve or work towards your personal, professional, or educational goals?

Background Check Notification*

Living History Farms will conduct a criminal background check as the final step before extending an offer of employment. A separate form requesting the information needed to conduct this check (social security number, birthdate, etc.) will be provided and must be completed before a job offer is made.

Yes, I understand.

Applicant's Statement*

I certify that the information on this application is true, complete, and correct to the best of my knowledge. I authorize Living History Farms to investigate and verify the information provided. I understand that if false information, omissions, or misrepresentations are discovered, my application may be disqualified or my employment may be terminated.

Yes, I agree.

Applicant's Signature*

Signature typed below constitutes a legal and binding signature.

Date*

MM

DD

YYYY

Upload Resume*

Upload Cover Letter*