Job Application Form Administrative Intern General Information Name* Date Address Phone Number* Email* Short Introduction How did you hear about us ? When are you available to work ? Mornings Afternoons Evenings Weekends Anytime Number of hours per week available to work Date available to begin work Are you at least 18 years old? Yes No Are you legally authorized to work in the U.S.? Yes No Have you ever been convicted of a crime or are you subject to any pending arrests? Yes No If so, please explain the circumstances of the conviction/s and the appropriate date/s Have you ever been discharged or asked to resign from any position? Yes No If Yes, please explain Education History School Attended City and State Years Attended Degree Received Employment History Employer 1 Employer Current Employer Start Date End Date Address Position held Reason for leaving Duties Supervisor’s Name Supervisor's Phone No. May we contact them ? Yes No References Name Company and Title Contact Information Relationship Resume By clicking this box, I certify that all information and answers provided herein are true and complete to the best of my knowledge. Further, I authorize contact of my past supervisors and references, as well as investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision. Finally, I understand that false or misleading information given in this application, related communications, or interviews may result in disqualification as a candidate, rescission of an offer of employment, or termination of employment. Applicant Name Date Submit
