Internship Application Form

Internship Application Form

First Name *

Last Name *

Street Address *

City *

State *

Zip Code *

Phone Number *

Email Address *

Birthdate +

School Name

(NOTE: Parental Consent Form is required for Interns under 18 years of age.)

Emergency Contact Name *

Phone Number *

Have you volunteered or interned with us before? If Yes, when and where?

Yes Yes

If Yes, when and where did you volunteer/intern?

Are you currently a student?

Yes

Is your intern experience education related?

Yes

What is your major?

Do you have a resume? Attach PDF or Word document here.

Is your intern experience credit-based? If Yes, include # of credits.
Note: The internship has to be for academic credit or offered through the school's program.

Yes Yes

Are you interested in a remote intern opportunity?

Yes

If Yes, are you able to complete your assignment using the basic essentials, such as your personal computer, internet connection, phone, email, etc.?

Yes

Who is your intern coordinator at high school or college? (Include name, phone, email address)

What do you hope to gain from your internship experience?

Are you currently working?

Yes

How soon would you like to start interning?

What field(s) are you interested?

Have you spoken to the intern site coordinator about the position? If Yes, include name and department.

Yes Yes

Is there any expertise or special experience you would like to offer? Please explain.

Times available to intern (select all that apply) *

Flexible

Morning

Afternoon

Evening

How many hours can you commit? *

Project-based

Semester

Hours per week Hours per week

For our record, have you ever been convicted or had adjudication withheld in a criminal offense, or are there any criminal charges pending against you? (Note: A conviction or adjudication withheld will not automatically disqualify you from volunteering with Pinellas County.) *

Yes

Acknowledgement Statement *

I certify that all statements made in this application are true, complete, and correct to the best of my knowledge and belief, and are made in good faith.

Your Name *

Today's Date * +

* Your e-mail address is required to submit this form. E-mail addresses are public records under Florida law and are not exempt from public-records requirements. If you do not want your e-mail address to be subject to being released pursuant to a public-records request, do not send electronic mail to this entity. Instead, contact this office by telephone (727-464-8477) or in writing, via the United States Postal Service to this address:

Pinellas County Volunteer Services

400 S. Fort Harrison Ave, 1st Floor, Suite 111
Clearwater, FL 33756

Career/Intern Fair	County Website
School Coordinator	Handshake
Social Media (Pinellas Volunteers)	Other Student
County Employee	Social Media (Pinellas Careers)
Other Other