Vermilion County Conservation District
Forest Glen County Preserve
20301 East 900 North Road
Westville, IL 61883
Application for Internship Program
Year
| A. Personal Information: | Social Security # | |
| Name: | ||
| Address: | ||
| City: | State: | Zip: |
| Phone Number: | ||
| Drivers License # | Class of License: | |
| B. Education: | ||
| Name and Location | Attended | Graduated |
| High School:__________________ ____________________________ ____________________________ |
__________________________ __________________________ __________________________ |
_________________________ _________________________ _________________________ |
| College: ____________________ ___________________________ ___________________________ |
__________________________ __________________________ __________________________ |
_________________________ _________________________ _________________________ |
| Curriculum: | ||
| Trade, Business or Correspondence School: | ||
| C. Former Work Experience: (List most previous first) | ||
| From (Mo./Yr.) To (Mo./Yr.) | Name and Address of Employer | Reason Left |
| 1. | ||
| 2. | ||
| 3. | ||
| 4. | ||
| D. During which time period are you available for? | ||
| Summer Session (12 wk.) | Fall Session (6 wk.) | Winter Session (6 wk.) |
| E. References: (General) | ||
| Name | Address | Occupation |
| 1. | ||
| 2. | ||
| 3. | ||
| Signature: | Date: | |