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Student Internship Application

FALL SPRING SUMMER       Year:
STUDENT INFORMATION
  Last First
Name:
Soc. Sec. #: --
Street:
City:
Telephone:  -  Zip: -
Message Phone:  -
ACADEMIC INFORMATION
  Current Major: 
  Units Now Enrolled In: 
  No. of Units Completed in Major: 
Educational Goal:
  AA  BA  Vocational Ed  Certificate  Other 
 
Degrees Completed:
Certificates Completed:
Other (specify):
EMPLOYMENT INFORMATION
Job Interest:
H1B Technoogy Program: Yes No
Location:
Hours & Days Available for Internship:
A.M.     P.M.    Weekdays   Weekends
Foreign Language:
Read     Write     Speak
Computer Skills:
Other Skills & Abilities:
WORK HISTORY  (Start with most recent & include salaried & volunteer positions)
Dates of employment
(From/To)		 Employer's name/Short description of duties
PLEASE SUBMIT YOUR CURRENT RESUME IF AVAILABLE

I certify that the information on this application is true and correct to the best of my knowledge and I authorize release of information on this application for employment purposes.

Type your legal name:
Please enter your email address:
Date: