(231) 788-5933spca@detours.net
Intern Application
Full Name:
Address:
City: State: Zip:
Home Phone: Work Phone:
Cell Phone:
I prefer to be contacted by phone at: Home Work Cell
Email:
Marital Status: Single Married
Birth Date:
Education (Select highest level completed): Junior High High School Undergraduate Graduate Doctorate
Dates Available - From: To:
Preferred Length of Internship:
Days you are available (Please check all that apply): Monday Tuesday Wednesday Thursday Friday Saturday Sunday
Time of day you’re available - From: To:
If chosen as an intern, would you prefer to stay onsite? Yes No
Do you have children? Yes No
Are there factors which could affect your availability? Yes No
If Yes - explain:
Year of Last Tetanus Shot: (Please note: It is strongly recommended that volunteers check with their doctors about receiving a current tetanus inoculation.)
Do you have health insurance? Yes No
If Yes, Name of Health Insurance Provider:
Do you have a valid driver’s license? Yes No
If Yes, Will you have a vehicle during your internship? Yes No
Have you ever been convicted of a felony pertaining to animals? Yes No
Emergency Contact
Phone: Relationship:
Personal References
List 2 people who have knowledge of your qualifications applicable for the intern position.
Full Name: Position:
Address: Phone:
Professional/Educational References
List 2 people not related to you who have knowledge of your qualifications applicable for the intern position.
Educational Information
College/High School:
Dates Attended:
Major Subjects:
Degrees Awarded:
Employment Information
Retired Student Employed
If employed - Company Name:
Title: Years of Service:
Volunteer Experience
Organization:
Position Held: Years of Service:
Application Agreement
