Application Form - Critter Care Wildlife Society

Critter Care Wildlife Society
Reset Form
Internship Application Form
Please answer honestly – do not simply write what you think we want to hear! We want to get to know
YOU!
Understand that internships are strictly volunteer positions and that you will not be paid any Monies,
but you will receive Room and Board.
Personal Information
Name:
Sex:
Male
Female
Date of Birth (month/day/year):
Current Address:
City:
State or Province:
Country:
Postal or Zip Code:
Permanent Address (if different):
City:
State or Province:
Country:
Postal or Zip Code:
Home Phone:
Work Phone:
Cell Phone:
Email Address:
Academic and Work Experience:
Present or Most Recent School Attended:
Dates:
Critter Care Wildlife Society - Internship Application Form 2012
Page 1 of 7
Is this Internship School related?
Yes
No
Yes
No
Yes
No
Yes
No
Do you smoke?
Yes
No
Do you have a valid driver’s license?
Yes
No
If yes, is it an international license?
Yes
No
What type of transmission can you drive?
Automatic
Major or Concentration (if applicable):
Dates:
Present or Most Recent Occupation:
Dates:
Responsibilities:
Past Internships:
If yes where?:
What were your duties?:
Volunteer/Community Work:
If yes where?:
What were your duties?:
Are you fluent in English?
Other languages:
Standard
Both
Critter Care Wildlife Society - Internship Application Form 2012
Page 2 of 7
Have you ever been charged or convicted of any crime?
Yes
No
Would you be willing to agree to a security check?
Yes
No
Do you have any experience with animals?
Yes
No
Do you have any pets?
Yes
No
Are you worried about zoonoses?
Yes
No
Do you know what zoonoses are?
Yes
No
Are you up to date on Tetanus shots?
Yes
No
If yes what?
If yes, what kinds?
In two or three paragraphs, describe yourself, including hobbies, interests, special skills etc.
Critter Care Wildlife Society - Internship Application Form 2012
Page 3 of 7
How did you hear about Critter Care’s internship program?
Why do you want to come to Critter Care? What do you feel that you will learn from your experience
here?
How do you feel that you can help our team?
What goals do you have for your stay at Critter Care? How do you plan on achieving them?
What are your future career or academic plans?
Critter Care Wildlife Society - Internship Application Form 2012
Page 4 of 7
Have you ever been involved in public relations or customer service?
Yes
No
If yes, please describe:
Is having a set work schedule important to you?
Yes
No
Have you ever traveled away from home on your own?
Yes
No
Have you ever lived on your own?
Yes
No
Have you ever been responsible for household chores? If so, what ones?
If given the choice, which would you prefer – working in a group or independently?
Group
Independently
Interning at Critter Care involves being on your feet for hours, repetitive work, physical labour like
carrying heavy objects, and outdoor work during all types of weather (painting, scrubbing etc.). This is
NOT a nine to five work experience! Are you willing and able to perform these types of duties?
Yes
No
Do you have any medical conditions or physical disabilities that may affect your performance (such as
allergies, asthma, injuries, or chronic illnesses)?
Yes
No
If yes, what are they?
Critter Care Wildlife Society - Internship Application Form 2012
Page 5 of 7
Emergency Contact Information:
Person to contact in case of emergency:
Relationship to you:
Home Phone Number:
Work Phone Number:
Cell Phone Number:
Email Address:
Health Insurance Information (required by our insurer):
Do you have health insurance?
Yes
No
Insurance Company Name:
Policy Number:
If you are NOT a Canadian citizen, you must bring $60 - $100 in cash in case you need to go to a
medical clinic. You may be reimbursed by your insurance company when you return home. Critter
Care will not be responsible for medical expenses.
Personal References (not a family member):
Name:
Relationship to you:
Home Phone Number:
Work Phone Number:
Cell Phone Number:
Email Address:
Academic, Work, or Volunteer References:
Name:
Occupation:
Work Phone Number:
Email Address:
You must send in a letter of recommendation along with this application.
Critter Care Wildlife Society - Internship Application Form 2012
Page 6 of 7
Desired Internship Dates:
Internships are 8 weeks in length or more. Priority will be given to applicants who can stay longer so
that the animals raised are weaned before their caregiver leaves.
Date to begin (month/day/year):
Date to end (month/day/year):
How flexible are the dates that you have chosen to be at Critter Care?
Notes:
1. Intern housing is available on a very limited basis. You will be sharing a space with other
interns, in either a basement room or one of two cabins.
2. You must supply some of your food, like meat and snacks, however Critter Carew Wildlife
Society will provide the basics. If you have any special dietary needs ie. vegan, food allergies
or intolerances, you will need to provide these for yourself.
3. Applications will be processed by CCWS Executive Director or Senior Wildlife Supervisor. Only
successful applicants will be notified.
4. Slackers need not apply.
Do you have any questions regarding Critter Care or the internship program?
If accepted for this internship, I agree to abide by the policies and procedures of Critter Care Wildlife
Society and to perform the duties of this position with a strong work ethic and a high level of personal
integrity. I agree to respect the philosophies of the organization and I will provide the best possible
care for the animals placed in my charge. I understand that internships are strictly volunteer
positions and that I will not be paid any monies but I will receive room and board.
Signature:
Date:
Critter Care Wildlife Society - Internship Application Form 2012
Page 7 of 7