FOR STUDENTS OR VOLUNTEERS ONLY
□
□
15.
Are you currently a
full time or
part time student?
□
□
16.
Will you receive school credit for this position?
Yes
No
If "Yes" please complete questions A-G)
a. Name of Advisor: _________________________________ b. Advisor's No. (______)_____________________
c. Total number of hours you must complete for credit ______ d. Hours per week you must work for credit ______
e. Placement deadline: _______/_______/_______
f. Date available to begin work: _____/_____/_____
g. Days and hours available to work:
Mon: ______
Tues: ______
Wed: ______
Thurs: ______
Fri: ______
□
□
17.
Are you eligible for Federal Work Study or other fellowship funding?
Yes
No
□
□
□
□
18.
Undergraduate status:
Freshman
Sophomore
Junior
Senior
Major: _________________________________
□
□
□
st
nd
Graduate status:
1
Year
2
Year
Other, Explain: ______________________________________
Major: _________________________________
19.
List all internship/volunteer experience (beginning with the most recent.)
a.
Name of Organization
_____________________________________________________________________
Address ___________________________________________________________________________________
Street
City
State/Zip Code
Supervisor's Name and Title _______________________________
Telephone No. (____)________________
Date Employed: From ____/____/____
To ____/____/____
Total Hours Interned or Volunteered _______
Nature of Work Assignment
______________________________________________________________
b.
Name of Organization
_____________________________________________________________________
Address ___________________________________________________________________________________
Street
City
State/Zip Code
Supervisor's Name and Title _______________________________
Telephone No. (____)________________
Date Employed: From ____/____/____
To ____/____/____
Total Hours Interned or Volunteered _______
Nature of Work Assignment
______________________________________________________________
20.
Why do you wish to intern/volunteer with the Office of the Attorney General?
__________________________________________________________________________________________________
__________________________________________________________________________________________________
21.
What do you expect to gain from this intern/volunteer experience?
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
- 3 -
HRM001 - (rev. 9/12)
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