Internship 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)
EDUCATION
INTERNSHIP INFORMATION
Term of Placement
Month
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Day
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Year
Month
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Day
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Year
EMPLOYMENT (List present and past employment beginning with the most recent)
REFERENCES

References must be non-relative and at least (1) reference must be a former employer. 

BACKGROUND INFORMATION

(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?
CERTIFICATION OF APPLICANT

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.