Intern App

City Department Internship Requested with:(Required)

Internship Degree Program:(Required)

Course Name:(Required)

Instructor:(Required)

Desired Start Date:(Required)

End Date:(Required)

Personal History

Name(Required)

First Middle Last

Please include your full middle name when submitting this application.

Phone Number(Required)

Address(Required)

Street Address Address Line 2 City State ZIP Code

Email(Required)

Are you at least 18 years of age?(Required)

List any relatives employed by the City of Marquette or serving as elected or appointed officials:

It is the policy of the City of Marquette not to employ an individual if he/she would be directly supervising or receiving direct supervision from a member of his/her family.

How were you referred to the City of Marquette? (If an advertisement, which publication or website?)(Required)

Have you ever been known by another name?(Required)

If yes, what name?(Required)

Do you possess a valid driver's license?(Required)

Has your license ever been revoked or suspended?(Required)

If yes, please explain:(Required)

Criminal History

Have you ever been convicted of a crime (including misdemeanors)?(Required)

Date of Conviction(Required)

Offense(Required)

Location of Conviction(Required)

City State ZIP Code

County of Conviction(Required)

Are there any felony charges pending against you?(Required)

Education

Indicate each school you are attending or have attended and the degree awarded.

High School(Required)

High School Address(Required)

Street Address City State ZIP Code

Graduation Status(Required)

If you have not received a high school diploma, have you passed a high school equivalency or GED test?

If yes, list location of test:(Required)

Post Secondary Schools

Please list the information of all post-secondary institutions you have attended below:

Select the number of years completed in a post-secondary school:

COLLEGE, UNIVERSITY, OR SCHOOL (1)

Address

Street Address City State ZIP Code

Are you presently attending this institution?

Major(s)/Field(s) of Study:

Degree Conferred & Year:

GPA

Please enter a number from 0 to 4.

COLLEGE, UNIVERSITY, OR SCHOOL (2)

Address

Street Address City State ZIP Code

Are you presently attending this institution?

Major(s)/Field(s) of Study:

Degree Conferred & Year:

GPA

Please enter a number from 0 to 4.

COLLEGE, UNIVERSITY, OR SCHOOL (3)

Address

Street Address City State ZIP Code

Are you presently attending this institution?

Major(s)/Field(s) of Study:

Degree Conferred & Year:

GPA

Please enter a number from 0 to 4.

Describe any education / training you have had which is not covered above, such as correspondence courses, service schools, in-service training - please give dates:

Employment History

You may attach a brief resume to further explain your qualifications; however, you must complete all the information below to be considered for a position. List most recent employment first.

Employer's Name (1)

Employment Status

Starting Date

Ending Date

Employer’s Phone Number

Employer’s Address

Street Address Address Line 2 City State ZIP Code

Title of Your Present / Most Recent Position

Hours Each Week

Present / Ending Salary

Name and Title of Supervisor

Name and Title of Next Higher Supervisor

Primary Duties

Reason for Leaving / Considering Change

Employer's Name (2)

Starting Date

Ending Date

Employment Status

Employer’s Phone Number

Employer’s Address

Street Address Address Line 2 City State ZIP Code

Title of Your Present / Most Recent Position

Hours Each Week

Starting Salary

Present / Ending Salary

Number of Employees You Supervised

Name and Title of Supervisor

Name and Title of Next Higher Supervisor

Primary Duties

Reason for Leaving / Considering Change

Employer's Name (3)

Please start with your most recent employment.

Starting Date

Ending Date

Employment Status

Employer’s Phone Number

Employer’s Address

Street Address Address Line 2 City State ZIP Code

Title of Your Present / Most Recent Position

Hours Each Week

Starting Salary

Present / Ending Salary

Number of Employees You Supervised

Name and Title of Supervisor

Name and Title of Next Higher Supervisor

Primary Duties

Reason for Leaving / Considering Change

Suspension/Involuntary Termination

Have you ever been suspended or involuntarily terminated from any position?(Required)

If yes, please explain:(Required)

References

Identify three references we may contact.

Reference Name

First Last

Reference Address

Street Address Address Line 2 City State ZIP Code

Reference Name

First Last

Reference Address

Street Address Address Line 2 City State ZIP Code

Reference Name

First Last

Reference Address

Street Address Address Line 2 City State ZIP Code

Attachments

Attach a 1-2 page essay describing your career goals and explaining how this internship will assist in the advancement of these goals.

File

Max. file size: 512 MB.

Attach documentation indicating the credit hours to be earned from this internship, or any papers or other projects that may be required at the conclusion of the internship along with the supervising instructor's signature.

File

Max. file size: 512 MB.

Please attach any evaluation criteria from your institution.

File(Required)

Max. file size: 512 MB.

Resume

File

Max. file size: 512 MB.

I hereby certify that all statements made on or in connection with my application are true, complete and correct to the best of my knowledge and belief, and I understand and agree that any misstatements or omissions of material fact subject me to disqualification or, if hired, dismissal.(Required)

I authorize my current and all previous employers to cooperate with the City of Marquette and to release, on a confidential basis, any information they may have concerning me including any information contained in my personnel record or otherwise known by them to the City of Marquette in connection with my application for internship with the City of Marquette. I specifically release from liability any current or former employer, its agents, representatives, employees, officers or directors for giving such information to the City of Marquette.(Required)

I understand that if certain positions have particular security requirements or if the City of Marquette determines there is a Bona Fide Occupational Qualification inherent in the position which requires certain information, a police background check seeking that information may be conducted prior to making a decision regarding an internship. I authorize the City of Marquette, its officers, agents, and employees to conduct such a check if I am applying for one of these positions, and I release and hold harmless the City of Marquette, its officers, agents, and employees from any liability related to the performance or result of this check.(Required)

I agree that any action or suit against the City, its agents or employees, arising out of my internship or termination of internship, including but not limited to claims arising under State and Federal law, (but not Federal civil rights statutes containing a separate limitations period), must be brought within 180 days of the event giving rise to the claim(s) or be forever barred.(Required)

I understand that all internships will be considered unpaid; however, all interns must be currently enrolled in an accredited college or university and receive course credit from their school for their participation in the internship program. Further, City of Marquette internships are offered without entitlement to or expectation of a paid position at the conclusion of the internship.(Required)

I understand that all interns will be required to adhere to all of the policies and procedures in effect at the City of Marquette during the internship.(Required)

I understand the City of Marquette reserves the right to reject any and all requests by students or universities for internship placements.(Required)

I understand interns are not City of Marquette employees and I must sign a waiver of liability.(Required)

Signature(Required)

Date(Required)

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What information can we help you find?

Internship Application

Personal History

Criminal History

Education

Post Secondary Schools

Employment History

Suspension/Involuntary Termination

References

Attachments