Intern Application
This is an unpaid position

PERSONAL INFORMATION DATE: _______________

NAME___________________________________________________

AGE: _____(if less than 18 years. of age) SSN: ____

ADDRESS: ___________________________________________________

PHONE: _________________________________________

Have you ever been convicted of violating any laws other than minor traffic offenses? _______
If yes, please explain _____________________________________________________________

EDUCATION	NAME AND LOCATION OF SCHOOL	YEARS ATTENDED	GRADUATE (YES/NO)	SUBJECTS STUDIED
High School
College
Vocational
Other

PREVIOUS EMPLOYMENT (List most recent first)

DATE	NAME/ADDRESS OF EMPLOYER	SUPERVISOR	SALARY	REASON FOR LEAVING
FROM:	NAME:	NAME:
TO:	ADDRESS:	PHONE:

Your position and responsibilities: ____________________________________________________

________________________________________________________________________________

PREVIOUS INTERNSHIPS (List most recent first)

DATE	NAME/ADDRESS OF EMPLOYER	SUPERVISOR	SALARY	REASON FOR LEAVING
FROM:	NAME:	NAME:
TO:	ADDRESS:	PHONE:

Your position and responsibilities: _____________________________________________________

_________________________________________________________________________________

REFERENCES

_____________________________________________________________________________________________
Name Address Phone # Relationship to you

____________________________________________ _______________
Signature Date

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Send to:
Euducation Department
Rolling Hills Wildlife Adventure
625 North Hedville Rd
Salina, KS 67401