Internship Application


Contact Information 
First Name* 
 
 
  
Street Address* 
 
City* 
 
State* 
 
Zip* 
 
Phone* 
 
Email* 
 


Emergency ContactWho should we contact in case of emergency?
Emergency Contact Name* 
Relationship* 
Emergency Contact Phone* 


Applicant Information Have you previously applied with SCALA?*



Are you physically able to perform the minimal requirements of the job for which you are applying?*



Are you legally eligible for employment in the U.S.?*


When will you be available to begin work?* 
 
Are you available for work?* 
 
 
Are you a licensed driver?* 

License Number 
Issuing State
 
Expiration Date
Have you ever been convicted of any Federal, State, County or Municipal Felony?*


If yes, please explain*


Education and Training 
High School 
Graduate? 
   
   
   
Diploma/Degree 
 
College 
 
Graduate? 
   
   
   
Diploma/Degree 
Other 
 
Graduate? 
   
   
   
Diploma/Degree 
 
Special Training or Skills, Software knowledge (please list) 

EmploymentBegin with the most recent position and give exact dates.

Company 
 
Position Held 
  
State Date
End Date
Street Address
City
State
  
Zip
Phone Number 
 
Contact / Supervisor Name 
 
Duties and Responsibilities
Reason for Leaving

ReferencesPlease list three individual who are not relatives

Reference #1 Name 
Company / Title 
Phone Number 
Reference #2 Name 
 Company / Title 
Phone Number 
Reference #3 Name 
Company / Title 
Phone Number 


Internship Details 
Desired Date to Begin Internship* 
Desired Date to End Internship* 
Are you looking for a:  
   
    
   
Availability to work or preferred schedule

Acknowledgement and Signature By electronically signing this application for internship, I certify that all information in this application is true and correct to the best of my knowledge. I also certify that if chosen for an internship I will abide by the Internship Policies and Procedures listed above. 

Signature*