Internship/Work Study Application

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Are there any health issues or physical limitations that could affect internship work or require placement modifications?
(Including employment and volunteer applications)
Term of Placement
EMPLOYMENT (List present and past employment beginning with the most recent)
VOLUNTEER EXPERIENCE (List present and past volunteer and military experience beginning with the most recent)

References must be non-relative and can not be former employers


(Please answer the questions below as completely as possible.)

Do you have any pending charges of a violation of law other than a minor traffic violation?
Have you ever been convicted of a violation of law other than a minor traffic violation?
Were you referred to CEDARS by a current CEDARS employee?

By submitting this form, you certify that the information contained in this application is true to the best of your knowledge and belief. You understand that any material omission of facts or misrepresentation may result in your discharge, if hired, regardless of when discovered. Unless otherwise expressly stated in a written appointment to a position or in a written contract of employment duly approved and executed by CEDARS, employees are considered at will, and either CEDARS or the employee may terminate the employment relationship upon giving the proper advance notice. You grant permission to CEDARS to investigate your employment record, educational record, criminal record and other records to verify the information you have provided on this application and release CEDARS from any liability resulting from such investigation.