King’s Ranch Internships

Application for internship

Applicant Information

Name

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone Number

(###)

###

####

Date of Birth

YYYY

Social Security Number

Please list all social media accounts/handles.

Marital Status

Single

Married

Divorced

If married, please list your spouse's name and occupation below.

Do you have children?

If yes, please list their names and ages below.

Personal Information

Do you have any friends, relatives, or acquaintances working for King’s Ranch?

If yes, state name and relationship.

Are you willing to submit and pass a background check?

Have you ever been convicted of a felony or misdemeanor?

If yes, please describe the crime, state nature of the crime(s), when and where convicted and disposition of the case.

Education, Training and Experience

High School:

School Name

First Name

Last Name

School Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Did you graduate?

Degree/diploma earned:

College/University:

Name of College/University

Field of Study

Name of Supervisor:

First Name

Last Name

Supervisor Email

Supervisor Phone Number

(###)

###

####

Internship Start Date:

YYYY

Internship End Date:

YYYY

Related details:

Do you have experience working with children from trauma? If yes, please describe

Additional Information:

Do you speak, write or understand any foreign language?

If yes, describe which language(s) and how fluent of a speaker you consider yourself to be.

Do you have any other experience, training, qualifications, or skills which you feel should be brought to our attention, in the case that they make you especially suited for an internship with us?

If yes, please explain:

Do you have interest in being a Therapeutic Respite Provider?

Identify one strength and one weakness. Describe each below.

Personal References

List below three persons who have knowledge of your work performance within the last four years. Do not list immediate family members.

Reference 1

Name

First Name

Last Name

Phone

(###)

###

####

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Occupation

Years acquainted

Reference 2

Name

First Name

Last Name

Phone

(###)

###

####

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Occupation

Years acquainted

Reference 3

Name

First Name

Last Name

Phone

(###)

###

####

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Occupation

Years acquainted

Please read and initial each paragraph, then sign below.

I certify that I have not purposely withheld any information that might adversely affect my chances for an internship. I attest to the fact that the answers given by me are true and correct to the best of my knowledge and ability. I understand that any omission (including any misstatement) of material fact on this application or on any document can be grounds for rejection of application or, if I am placed at King’s Ranch, terms for my immediate expulsion from the internship program.

I permit King’s Ranch to examine my references, education record, and any other information provided. I authorize the references I have listed to disclose any information related to my education and my professional experiences with them, without giving me prior notice of such disclosure. In addition, I release King’s Ranch, my former employers and all other persons, corporations, partnerships and associations form any and all claims, demands or liabilities arising out of or in any way related to such examination or revelation.

Applicant's Signature

Date

YYYY

King’s Ranch Internships

Application for internship

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