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Internship Application

Area 10 Agency on Aging is an equal opportunity employer and will not discriminate, or tolerate discrimination, against any applicant in any manner prohibited by law.

About You
About the Internship

(check all that apply)

If this internship will help to complete university requirements, please explain the type of activities or projects required for your program, including the level of mentoring or supervising required, and other relevant information (course, professor, etc.) to help us determine if this internship would be a good fit.

Employment History

References

Reference 1

Reference 2

Reference 3

I verify that all of the information above is correct and true to the best of my knowledge. I am interested in interning at Area 10. I understand that all information is kept strictly confidential. I give Area 10 the right to investigate all references. I hereby release the use of my photograph, and understand that the photograph may be used for a variety of purposes, including, but not limited to, newspapers, websites, brochures, and newsletters. I release Area 10 Agency on Aging from any claim which may arise from participation in Area 10 activities. My signature also verifies my permission to run a criminal background. I agree to notify Area 10 immediately if anything changes that would affect the results of my background check.