Get Healthy Howard Internship Application Form

Healthy Howard Inc. APPLICATION FOR INTERNSHIP An Equal Opportunity Employer basis of race color creed religion sex age marital status national origin sexual orientation genetic information or status as a veteran or qualified disabled person or on any other basis prohibited by applicable laws. Please note that Healthy Howard Inc* requires an intern to have completed AT LEAST 60 CREDIT HOURS by the start date of the internship to be considered* Please attach a resume and a statement of why you would like to intern for Healthy Howard. Applicant s Name Last First Middle Address Number Street City State Zip Code Telephone Number Day Evening Dates Available must be available for a minimum 16 hours per week for 8 weeks EDUCATION Name and Location of School Circle Last Year Completed Did You Graduate Major Course Degree Received High School 1 2 3 4 College 1 2 3 4 LIST ANY SPECIAL EXPERIENCES QUALIFICATIONS OR SKILLS YOU HAVE THAT YOU BELIEVE WOULD HELP YOU DO THE INTERNSHIP APPLIED FOR THAT YOU BELIEVE WOULD HELP YOU DO THE INTERNSHIP APPLIED FOR List Licensing Authority License Number and Date of License for each PRIOR EMPLOYMENT Give the following information for all present and previous employers beginning with the most recent. Employer Name Address and Phone Number Dates of Employment Job Title Were you ever disciplined Warnings Suspension Discharge Yes No Reason for Leaving PROFESSIONAL REFERENCES Give below the names of at least two persons with whom you have worked or studied under. Institution/Position Email Phone Number Date Signature of Applicant potential candidate for internship if the position will have access to data that is deemed to be of a sensitive nature. Please email fax or mail completed application packets to 866-989-5551 PO Box 2275 Columbia MD 21045. Please note that Healthy Howard Inc* requires an intern to have completed AT LEAST 60 CREDIT HOURS by the start date of the internship to be considered* Please attach a resume and a statement of why you would like to intern for Healthy Howard. Applicant s Name Last First Middle Address Number Street City State Zip Code Telephone Number Day Evening Dates Available must be available for a minimum 16 hours per week for 8 weeks EDUCATION Name and Location of School Circle Last Year Completed Did You Graduate Major Course Degree Received High School 1 2 3 4 College 1 2 3 4 LIST ANY SPECIAL EXPERIENCES QUALIFICATIONS OR SKILLS YOU HAVE THAT YOU BELIEVE WOULD HELP YOU DO THE INTERNSHIP APPLIED FOR THAT YOU BELIEVE WOULD HELP YOU DO THE INTERNSHIP APPLIED FOR List Licensing Authority License Number and Date of License for each PRIOR EMPLOYMENT Give the following information for all present and previous employers beginning with the most recent. Applicant s Name Last First Middle Address Number Street City State Zip Code Telephone Number Day Evening Dates Available must be available for a minimum 16 hours per week for 8 weeks EDUCATION Name and Location of School Circle Last Year Completed Did You Graduate Major Course Degree Received High School 1 2 3 4 College 1 2 3 4 LIST ANY SPECIAL EXPERIENCES QUALIFICATIONS OR SKILLS YOU HAVE THAT YOU BELIEVE WOULD HELP YOU DO THE INTERNSHIP APPLIED FOR THAT YOU BELIEVE WOULD HELP YOU DO THE INTERNSHIP APPLIED FOR List Licensing Authority License Number and Date of License for each PRIOR EMPLOYMENT Give the following information for all present and previous employers beginning with the most recent. Employer Name Address and Phone Number Dates of Employment Job Title Were you ever disciplined Warnings Suspension Discharge Yes No Reason for Leaving PROFESSIONAL REFERENCES Give below the names of at least two persons with whom you have worked or studied under.