Untitled Document

Florida Wildlife Hospital & Sanctuary, Inc.

Intern Application

Last Name:_______________________________ First Name:________________________

Address:__________________________________________________________________

_________________________________________________________________________

City: ____________________________________ State:_________ Zip:________________

Phone(s):__________________________________________________________________

Email:_____________________________________________________________________

Date of birth:_______________________________________________________________

Person to contact in case of emergency:

Relationship_________________________________________________________________
Name_____________________________________________________________________
Address___________________________________________________________________
Phone(s)___________________________________________________________________

Do you have medical insurance? YES NO
Name of insurance company:____________________________________________________

I have a current tetanus shot: YES NO

Name of school currently attending:_______________________________________________

Years completed as of May 2009:________________________________________________

Field of study:_______________________________________________________________

How did you hear about this internship?

__________________________________________________________________________

What, if any, extra-curricular activities have you participated in and for how long? (high school and/or college)
__________________________________________________________________________

__________________________________________________________________________

4560 North U. S. Highway 1 – Melbourne, FL 32935 – 321 254-8843

FWH 2009

Last Name:___________________________ First Name:____________________________

Do you have any medical condition or allergies that requires special accommodations? YES NO

If yes, please explain: _________________________________________________________

__________________________________________________________________________

Do you have you any experience with wildlife, domestic, or exotic animals? YES NO

If yes, list species worked with, type of experience and location of experience.
__________________________________________________________________________

__________________________________________________________________________

Do you have any other special skills?
__________________________________________________________________________

__________________________________________________________________________

__________________________________________________________________________

Do you require housing? YES NO

What is your method of transportation? ____________________________________________

__________________________________________________________________________

The above information is true to the best of my knowledge. I understand that falsification of information may be cause for dismissal.

Signature:________________________________________________ Date:__________________

4560 North U. S. Highway 1 – Melbourne, FL 32935 – 321 254-8843

FWH 2009

Please include the following supporting documents:

1. Two letters of reference including addresses and contact numbers from two individuals not
related to you who have known you for over a year.
2. Employment history with name of company, name of supervisor, telephone numbers, start and
end dates, brief description of duties.
3. Essay “What I hope to gain from this experience” of at least 100 but no more than 300 words.

Applications are due March 31, 2009. Applications will be reviewed as they are received and interviews scheduled after a signed internship agreement is received. If you are selected, proof of tetanus immunization will be required prior to starting date.

4560 North U. S. Highway 1 – Melbourne, FL 32935 – 321 254-8843

FWH 2009