Form Builder

Last name

First name

Middle name

Address

Street Address

City

State

Zip

Phone number

Email address

School

School contact person and title

School contact person email

School contact person phone

When is your anticipated/desired start date?

When is your anticipated end date?

How many hours per week?

Days/Times you are available?

What are your school's internship requirements?

How many hours are required for the semester?

Have you completed the Competencies of Child Welfare class(are you a collaborative student)?

What are the requirements of the field supervisor?

Is this a Service Learning experience?

What is your area of study or degree you will be awarded?

What is your anticipated graduation date?

What classes/courses are you currently taking?

Please list any relevant work or volunteer experience

What is your current knowledge of DSS and our services?

Why do you desire an internship at DSS?

What do you hope to learn during your field experience at DSS?

What area in DSS would you hope to complete an internship?

List 3 things you do well at the moment

List 3 things you would like to learn to do better

Using 3 words, how would your friends describe you?

What acheivements in your life are you most proud of and why?

What are your plans for the future?

Tell us something about yourself that you think is unique and would be the one thing that makes you stand out from the other candidates applying for an internship.

Will you be seeking employment in the Hickory area immediately following your internship?

Today's date

REMEMBER: Inclusion of your school internship requirements is mandatory for you to be considered for an internship. Please send a copy of your school’s internship requirements to lmitchell@catawbacountync.gov.

Catawba County is an affirmative action/equal employment opportunity employer. Discrimination because of race, color, religion, sex, handicap, sexual orientation or national origin is prohibited.

I agree

The above information is true to the best of my knowledge. I understand that if I give false information, my internship may be terminated. You must check this box or the form will not be submitted.