Internship Application

Internship Program

Please fill out the application below and attach a resume, essay and transcript as one PDF file as described below(8 MB file size limit). The essay should address the following topics:

What interests you in science (or specialized area) and why?
How does the Internship support your interest and professional goals?
What strengths would you bring to the Internship?
Let us know something about yourself that we might not learn from the rest of this application.

Name

First Name *:

Middle Name:

Last Name *:

If you are known by any other name, please give name.:

Current Address

Street *:

City *:

State / Province *:

Zip / Postal Code *:

Current Contact Information

Current Phone Number *:

Cell Phone Number:

Permanent Address

Street *:

City *:

State *:

Zip / Postal Code *:

Permanent Contact Information (if different from above)

Email Address *:

Type Email Address Again:

Permanent Phone Number *:

Work Eligibility

If you are under 18, can you furnish a work permit?

Yes

If no, please explain.:

If hired, can you prove you are eligible for employment in the USA? *

Yes

If no, please explain.:

Availability

Dates Available

Available From (mm/dd/yyyy) *:

Available To (mm/dd/yyyy) *:

Time each day *:

Have you ever applied for an internship or employment with the Venter Institute or The Institute for Genomic Research before? *

Yes

If yes, when and for what position?:

Which location are you interested in interning at? *

Maryland

California

Research Interests

Please indicate no more than 5 areas of research or administration you are interested in. *

Research Genomic Medicine

Synthetic Biology & Bioenergy

Microbial & Environmental Genomics

Infectious Disease

Plant Genomics

Informatics

Policy Center

Education

Environment, Health and Safety

Sequencing

Administration Human Resources

Accounting

Communications

Finance

Archives/Library

Legal

Information Technology

Education

	Name, City & State	Completed Status as of Spring 2011
High School or G.E.D.
College or University
Graduate Study
Graduate Study

	Major Field of Study	Specify Diploma, Degree, or Certificate Received
High School or G.E.D.
College or University
Graduate Study
Graduate Study

Experience

United States Armed Forces

Branch:

Rank:

If you serviced in the US Armed Forces, please describe any job-related training you received or skills you obtained.:

How were you referred to this organization?:

Are you currently receiving a stipend or compensation from your sponsoring institution? *

Yes

If yes, how much is the stipend?:

Employment History

INSTRUCTIONS: Please complete this section, beginning with your current or most recent position. By giving the names of your employers, we have your permission to contact them; however, we will not contact your present employer without first advising you of our intent to do so. If you need more space, or have additional employers, please attach a separate sheet of paper.

Current or Most Recent Employer

Name:

Street:

City, State, Zip:

Name and Title of Current or Final Supervisor:

Telephone:

Reason for Leaving:

Summary of Job Responsibilities:

Starting Date:

Final Date:

Starting Salary:

Starting Position:

Current or Final Salary:

Current or Final Position:

Employer

Name:

Street:

City, State, Zip:

Name and Title of Final Supervisor:

Telephone:

Reason for Leaving:

Summary of Job Responsibilities:

Starting Date:

Final Date:

Starting Salary:

Starting Position:

Final Salary:

Final Position:

Employer

Name:

Street:

City, State, Zip:

Name and Title of Final Supervisor:

Telephone:

Reason for Leaving:

Summary of Job Responsibilities:

Starting Date:

Final Date:

Starting Salary:

Starting Position:

Final Salary:

Final Position:

Additional Data

Describe any special skills you possess that may be relevant to this organization.:

If appropriate to the position for which you are applying, please complete the following:

Personal computers operated:

Software used:

Other equipment operated:

Have you been convicted of a felony, or released from prison, within the last seven years? A "yes" answer does not automatically disqualify you from further consideration, since the nature of the offense, date, and type of job for which you are applying will be considered. *

Yes

If yes, please explain:

Do you know of any reason which would prevent you from satisfactorily performing the essential functions of the internship for which you are applying? (If undecided, you may wait until the duties and responsibilities have been explained to you.)

Yes

If yes, please describe the restrictions or limitations.:

If the job requires, are you willing to travel, including overnight travel?

Yes

If the job requires, are you willing to work overtime?

Yes

References If you have no or limited work-related references, provide below the information requested for three persons not related to you whom you have known for at least one year. *

Name and Telephone Number	Occupation	Relationship	Years Known

Please provide any additional information which you feel may be helpful to us in considering your application.:

I certify that the statements made in this application are true and complete to the best of my knowledge. I understand that falsification or misrepresentation of information may result in the denial of employment or, if employed, immediate termination.

I authorize investigation of all statements contained herein. I understand that this organization will not contact my current employer without first advising me of its intent to do so. I authorize the references, educational institutions, employers, and other organizations listed above to give this organization any and all information concerning my educational background, current and/or previous employment, and any other pertinent information they may have, personal or otherwise. I release this organization, and all individuals, educational institutions, employers, and other organizations involved in the consideration of this employment application from all liability for any damage that may result from utilization of this information.

I understand and agree that no representative of this organization has authority to enter into any employment agreement unless it is in writing and signed by an officer of organization. I also understand that if I accept an offer of employment, I am required to provide acceptable documentation of my identity and eligibility for employment in the United States as required by the Immigration Reform and Control Act.

I understand that my employment is for no fixed period of time and may be terminated by me, or by this organization, at any time, for any reason, with or without notice. I further understand that this organization is an employment-at-will employer.

The statements made in this application are true and complete to the best of my knowledge.

It is the policy of this organization to consider all applicants equally without regard to race, national origin or ancestry, color, religion, creed, sex, age, marital status, presence of children, pregnancy, sexual orientation, genetic status, mental or physical handicap, status as a Vietnam Era or special disabled veteran, or status as a qualified disabled individual, and in accordance with all applicable laws, except where sex is a bona fide occupational requirement, or where disability status is a bona fide occupational disqualification or any other legally protected status.

The Employee Polygraph Protection Act generally prohibits most private employers from requiring or requesting lie detector or similar tests either for pre-employment screening or during the course of employment; and from discharging, disciplining, or discriminating against an employee or applicant for refusing to take a test or for exercising his/her rights under the Act.

MARYLAND APPLICANTS ONLY: UNDER MARYLAND LAW, AN EMPLOYER MAY NOT REQUIRE OR DEMAND, AS A CONDITION OF EMPLOYMENT, PROSPECTIVE EMPLOYMENT, OR CONTINUED EMPLOYMENT, THAT AN INDIVIDUAL SUBMIT TO OR TAKE A LIE DETECTOR OR SIMILAR TEST. AN EMPLOYER WHO VIOLATES THIS LAW IS GUILTY OF A MISDEMEANOR AND SUBJECT TO A FINE NOT EXCEEDING $100.

CALIFORNIA APPLICANTS ONLY: I understand that a private employer in California may not demand or require any employee or applicant to submit to or take a polygraph, lie detector, or similar test or examination as a condition of employment or continued employment. Labor Code section 432.2. An employer may not ask any person to take such a test or administer such a test without first advising the subject in writing at the time the test is to be administered of the rights guaranteed by that statutory section. A violation of Labor Code 432.2 is a misdemeanor.

I understand that I will not be required to submit to or take a polygraph, lie detector, or similar test or examination as a condition of employment or continued employment.

Please attach resume, essay, and transcript(s) as one pdf file. (8 MB file size limit)

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