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CHA Student Internship Program Application Summer 2013
- 1. CHA STUDENT INTERNSHIPAPPLICATION CONTACT INFORMATION Date: ___________________________________ First Name: ______________________________ Last Name: ___________________________________ Mailing Address: _________________________________________________________________________ City: _________________________________ State: ______________ Zip: ___________________ Home Telephone Number: ___________________ Cellular Telephone Number: ______________________ Which number do you prefer us to use to contact you? _______________ Fax Number: __________________________ Email Address: ________________________________ HOW DID YOU HEAR ABOUT THE CHA INTERNSHIP PROGRAM? ___Internet: Which site? _________ ___School: Which one? ________ ___ CHA Partnering Organization: Which? ___________ ___CHA Public Housing Bulletin ___Media (print, TV, radio) ___ Former/Current CHA Intern ___CHA Employee ___Referred by friend/relative ___Other:_______________________________ (specify) Qualified CHA residents are encouraged to apply. ` Are you currently a: Resident of a CHA Housing Development Recipient of a CHA Housing Choice Voucher (Section 8) If CHA Housing, which development_________________________________________________________ CHA Client ID Number______________________ CHA Head of Household Name____________________ CHA Internship – 14-Feb-13
- 2. EMPLOYMENT Place of employment(current or most recent): _________________________________________________ Job Title/Description: _____________________________________________________________________ Organization: ____________________________________________________________________________ Location: _____________________________________________________________________________ Month/Year to Month/Year: _____/_____ to _____/_____ Place of employment: ____________________________________________________________________ Job Title/Description: ____________________________________________________________________ Organization: __________________________________________________________________________ Location: _____________________________________________________________________________ Month/Year to Month/Year: _____/_____to _____/_____ EDUCATION & TRAINING College Current Year Major Date of Completion/ Degree or Certificate (i.e. fresh., soph) Expected Completion VOLUNTEER EXPERIENCE Please list your most recent volunteer experiences: Activity/Position: ______________________________________________________________________ Organization: _________________________________________________________________________ Location: _____________________________________________________________________________ Month/Year to Month/Year: _____/_____ to _____/_____ CHA Internship – 14-Feb-13
- 3. LANGUAGES Please list anylanguages, other than English, that you are able to speak fluently, read, or write. ______________________________________________________________________________________ REFERENCES Please provide two references (preferably at least one former work supervisor) that have known you for at least two years and are not related to you. Please let your references know that we may contact them. Name Telephone Number In what capacities do they know you? How long? ____________________________________________________________________________________________________________ Name Telephone Number In what capacities do they know you? How long? If selected, you must be available to work a 40 hour week. For Office Use Only: Interview Date: ________ Hire Date:________ CHA Internship – 14-Feb-13