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1. Full Name
First Name
Middle Name
Last Name
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2. E-mail address
Email
Verify Email
None
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3. Current Address
Street
Apt. No.
City
State
Zip Code
Phone
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4. Permanent Address
Street
Apt. No
City
State
Zip Code
Country (if applicable) Phone
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5. U.S. Citizen Status:
U.S. Citizen: Yes No
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Date of Birth: (mm/dd/yyyy)
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| If born in the US: |
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City of birth
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State of birth
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| If born outside
the U.S: |
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Country of birth
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City of birth
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Visa Type
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Expiration Date
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6. High School
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Month and year of Graduation: (mm/yyyy) Name of High School
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City and State
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7. Select the option that best describes your current
academic status.
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Freshman Sophomore Junior Senior Graduating
Senior Graduate Student
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8. Have you ever been convicted of a felony or misdemeanor?
Yes
No
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If yes, indicate when, where and describe offense:
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Applicant Demographic Data
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Applicant demographic data is important in assessing the effectiveness
of our efforts to solicit applications from a diverse population. Your
submission of this information will assist us in this regard. We
appreciate your cooperation. If you decline to provide this
information, it will in no way affect consideration of your application.
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| 9. Gender |
Male
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Female
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10. Ethnicity
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African American
Asian/Pacific Islander Caucasian American Hispanic
American
Native American Other
(Note: Native American = American Indian, Eskimo, and
other original peoples of North America)
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11. Special Needs (e.g. visually impaired)
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12. Primary spoken language
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13. Other languages you speak
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Applicant School Information
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Students are strongly encouraged to obtain credit from their
educational institutions for this internship experience. To make
arrangements for credit for "independent study," contact any of your
instructors, your academic advisor, or your school's career placement
center to determine the process.
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If you are selected as an Intern in this program, will you receive
academic credit at your college/university for participating?
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Yes
No
Do not know Not applicable
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14. College/University Currently Attending
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College/University
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Address City State Zip
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Date Started Major
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Minor (if applicable) Expected Graduation Date
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Expected degree: 2 Year Associate
BA
BS
MA
MS PhD
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15. Please provide the following information about
your current academic advisor.
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Name
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E-mail
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Phone
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16. The appointment term for which you are applying
is:
Spring
Summer Fall
Winter
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17. a. What is the earliest date you can begin your
internship?
b. By when do you need to complete your
internship?
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18. List all other colleges and universities that you
have previously attended (enter "NONE" if
appropriate). Include approximate
dates of attendance and indicate any degrees earned:
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College/University
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Dates Attended
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19. Certification of minimum GPA and minimum age eligibility
requirements:
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My cumulative GPA for all completed coursework is
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I will be 18 years of age or older at the time of the
internship.
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20. Academic Honors or Awards. Enter "NA" if
appropriate:
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21. List all courses you are currently taking. Enter
"NA" if appropriate.
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1.
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2.
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3.
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4.
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5.
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6.
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22. In the sections below, indicate your proficiency
in the following areas/instruments.
(1 = No Experience, 5 = Proficient)
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Computer Aided Design Software (CAD)
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Spreadsheets
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Statistical Analysis Software (SAS)
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Word Processing
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23. List any additional computer related
skills/experience you may have:
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24. List any programming languages you
know (e.g., C, Pascal, HTML, Java, etc.):
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25. Discuss any special areas of interest you would
like to focus on or develop during your internship.
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Graduating Senior Information
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In order to be eligible for a internship, you must be a college or
university student. If you are a graduating senior, and your graduation
date is scheduled before your internship begins, please answer the
following question:
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26. Have you applied or are you planning to apply to graduate school?
Yes
No
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If so, which graduate school and in what academic
field?
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27. List names of any relatives employed by Hanford Contractors
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28. Referral Source:
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Resume Attachment
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Paste your resume here (text only).
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End of Application
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I understand that all information in the application will be provided
to the contractors who are involved in selecting participants.
I certify that to the best of my
knowledge all information contained in this application is accurate.I
understand that any falsification will render me ineligible for
participation.
If you are selected for an internship,
you will need to provide your current college transcript. An
'unofficial' copy is acceptable.
If you are selected for an internship,
you will be required to provide your Social Security Number for
security and on-site badging purposes.
Employment at Columbia Industries is on
an “at-will” basis and is for no definite period and
regardless of the date or method of payment of wages or salary, be
terminated at any time with or without cause. Other than the president
of Columbia Industries, no supervisor, manager, or other person,
irrespective of title or position, has authority to alter the at-will
status of your employment or to enter into any employment contract for
a definite period of time with you. Any agreement with you altering
your at-will employment status must be in writing and signed by the
President of Columbia Industries and /or Human Resources Manager.
I expressly authorize, without
reservation, Columbia Industries, its representatives, employees or
agents to contact and obtain information from all references (personal
and professional), employers, public agencies, licensing authorities
and educational institutions and to otherwise verify the accuracy of
all information provided by me in this application, resume or job
interview. I hereby waive any and all rights and claims I may have
regarding the employer, its agents, employees or representatives, for
seeking, gathering and using such information in the employment process
and all other persons, corporations or organizations for furnishing
such information about me.
I understand that if driving is a part of
the position I am applying for, I will need to obtain and submit a
driving record from the Department of Motor Vehicles.
I understand that the employer does not unlawfully discriminate in
employment and no question on this application is used for the purpose
of limiting or excusing any applicant from consideration for employment
on a basis prohibited by applicable local, state or federal law.
This application does not constitute an agreement or contract for
employment for any specified period or definite duration. I understand
that no supervisor or representative of Columbia Industries is
authorized to make any assurances to the contrary and that no implied
oral or written agreements contrary to the foregoing express language
are valid unless they are in written and signed by Columbia
Industries’ President and/or Human Resource Manager.
I also understand that if I am hired, I will be required to pass a
criminal background check, possible random drug screen, and provide
proof of identity and legal authority to work in the United States, and
that federal immigration laws require me to complete an I-9 Form in
this regard.
If employed, I agree that all material created and produced whether in
written, graphic or broadcasting form, all inventions, new or changes
in processes developed during my employment, are the exclusive property
of the company to use and/or sell and that subsequent to my employment
with this company.
I will not disclose, use or reveal any confidential information related
to the company without first obtaining written consent from an officer
of the company.
I certify that all information I have provided in order to apply for
and secure work with Columbia Industries is true, complete and correct.
I understand that any information provided by me that is found to be
false, incomplete or misrepresented in any respect, will be sufficient
cause to (i) cancel further consideration of this application, or (ii)
immediately discharge me from the employer’s service, whenever it
is discovered.
I hereby apply for employment upon the basis and understanding that
such employment may be terminated at any time upon notice given to me
personally or sent to my last known address.
DO NOT SUBMIT UNTIL YOU HAVE READ THE ABOVE APPLICANT STATEMENT.
(Note: You must certify
that you agree with this before you can be considered for selection.)
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You must authenticate this form by typing the two
words show in the image below.
(If you cannot read the words, you may refresh the image by clicking
the first orange icon.)
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Yes, I agree Today's Date:
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Thank you for your interest in CI
Student Staffing! If you are chosen, you will be notified via phone and
email.
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