Internship/Research Volunteer Application
By signing this document "I certify that the information in this application is accurate, current and complete. I understand that misstatements or omissions may result in disqualification from further consideration. I authorize the Amazon Research Center for Ornamental Fishes to contact my reference or any of my former employers directly concerning my work habits, character or skill, and any other data required, in connection with this application."
Application for:
Internship
Research Volunteer
First Name
Last Name
Address
Phone Number
Email address
Date of Birth:
Emergency Contact Relationship
Emergency Contact Name
Emergency Contact Address
Emergency Contact Phone Number
Physician's Name
Physician's Phone Number
Do you have medical insurance?
Yes
No
Name of Insurance Company
I have current tetanus shot (required) - within the past 10 years.
Yes
No
I have current yellow fever vaccination (required) - within the past 6 years.
Yes
No
Do you have a medical condition or allergies requiring special accommodations?
Yes
No
If yes to the above question, please explain.
This internship requires physical labor, heavy lifting, long periods of standing and walking, and working outside in all types of weather. Do you have any health conditions or physical limitations that would limit your internship duties?
Yes
No
If yes to the above question, please explain.
Name of School/University currently attending
City
State
Field of Study
Previous University/College attended:
City
State
Years completed as of date of application
Field of Study
List any science/wildlife ecology courses have you taken (attach transcripts if you have)
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For what time period of internship/volunteer are your applying (dates)
What, if any, extra-curricular activities have you participated in and for how long? (high school and/or college)
Do you have any experience with wildlife, domestic, or exotic animals? List species worked with, type of experience, and location of experience.
Please list any other work related information you think would be helpful to us in considering you for an internship, such as courses completed, work experience, volunteer work, accomplishments, etc.
Do you have any other special skills?
Languages Spoken (Spanish not required)
Please include one letter of reference including addresses and contact numbers from teacher/professor at your present high school/university.
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Your Signature
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