JCG 2021 Work Experience Opportunity - INTERNSHIP APPLICATION

JCG 2021 Work Experience Opportunity
Internship Application

Name

School

Grade

Work Experience you are applying for

Career / Field of Interest

Home Address

Zip Code

Neighborhood

Phone

Date of Birth

Age

Gender

Emergency Contact Name

Emergency Contact Phone

Do you currently have a mentor?

Mentor Name

Mentor Professional Title

Program Affiliate

If you are currently working, what is your work schedule? (In hours)

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Sunday

Will you be involved in any school or extra-curricular activities during the internship? If so, please provide the dates/times/schedule below.

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Sunday

If you do not have personal transportation, how will you get to and from work?

Some of the partner sites may require background checks, and/or drug testing; will this be an issue? (Answering “Yes” does not disqualify you from this opportunity)

Have you ever been suspended or expelled?.

If so, please explain

Do you have a record?

If you have a child(ren), do you have stable childcare?

If you have employment experience, list your job title(s), employer(s), and dates employed; if the employment was for a summer job only, indicate “summer” for the dates.

Job Title 1

Employer 1

Dates 1

Job Title 2

Employer 2

Dates 2

Job Title 3

Employer 3

Dates 3

Job Title 4

Employer 4

Dates 4

Reference (Non-JCG Affiliate):

Name

Phone

Title

How long have you known them?

Name

Phone

Title

How long have you known them?

All items included on this application are accurate to the best of my knowledge.

JCG 2021 Work Experience Opportunity Internship Application

JCG 2021 Work Experience Opportunity
Internship Application