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Internship Application
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Name:
(Required)
First
Last
Address:
(Required)
Street Address
Address Line 2
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
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Guam
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Utah
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Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Is Your Mailing Address Different Than the Address Above?
(Required)
Yes
No
Mailing Address:
(Required)
Street Address
Address Line 2
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Phone:
(Required)
Email:
(Required)
Date of Birth:
Month
1
2
3
4
5
6
7
8
9
10
11
12
Day
1
2
3
4
5
6
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11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Year
2025
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
Emergency Contact Information
Emergency Contact:
(Required)
First
Last
Relationship:
(Required)
Phone:
(Required)
Background
Are you 18 years old or older?
(Required)
Yes
No
Have you ever been convicted of a felony?
(Required)
Yes
No
The existence of a conviction does not automatically disqualify an individual from volunteering. Each case is judged on its own merit with respect to the related volunteer duties.
Please Explain:
(Required)
References
Please list two personal references. Including complete the address and phone numbers.
Reference One
(Required)
Name
Address
Phone
Email
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Reference Two
(Required)
Name
Address
Phone
Email
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Reference Three
(Required)
Name
Address
Phone
Email
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Please initial (this will be used as your signature)
(Required)
I have authorized LifeStream Services, Inc. to contact my current and any former employers and/or references in order to investigate my past performance and other information contained on my application. I further authorize my current and former employers and/or references to respond to the questions set forth by LifeStream Services, Inc. and its designated representatives.
Confidential Background Check Authorization
Background Check Authorization
(Required)
By checking each box, you acknowledge that you have read and agree to these statements.
I hereby authorize LifeStream Services, Inc. and its designated agents and representatives to conduct a comprehensive review of my background causing a consumer report and/or an investigative consumer report to be generated for employment processes. I understand that the scope of the consumer report/investigative consumer report may include, but is not limited to the following areas: verification of social security number; current and previous residences; employment history, education background, character references; drug testing, civil and criminal history records from any criminal justice agency in any or all federal, state, county jurisdictions; driving records, birth records, and any other public records.
I further authorize any individual, company, firm, corporation, or public agency (including the Social Security Administration and law enforcement agencies) to divulge any and all information, verbal or written, pertaining to me, to LifeStream Services, Inc. or its agents. I further authorize the complete release of any records or data pertaining to me which the individual, company, firm, corporation, or public agency may have, to include information or data received from other sources.
I further authorize LifeStream Services, Inc. to do an annual and/or random background checks for the purpose of evaluating my continued employment.
I understand pursuant to the federal Fair Credit Reporting Act, LifeStream Services, Inc. will provide me a copy of any such report if the information contained in it is, in any way, to be used in making a decision regarding my employment and/or continued employment with LifeStream Services, Inc. I further understand that such report will be made available to me prior to any such decision being made.
I hereby release LifeStream Services, Inc., and its agents, officials, representative, or assigned agencies, including officers, employees, or related personnel both individually and collectively, from any and all liability for damages of whatever kind, which may, at any time, result to me, my heirs, family, or associates because of compliance with this authorization and request to release.
Please initial (this will be used as your signature)
(Required)
Internship Information
I'm interested in volunteering in the following areas:
(Required)
Social Services/Care Management
Administration
Finance
Public Relations/Marketing
Development/Fundraising
Graphic Design
Please specify internship semester:
(Required)
Fall
Spring
Summer
University/College Attending:
(Required)
Major:
How many hours will you be committing each week?
(Required)
How many hours does your internship require?
Availability:
(Required)
Mornings = 8am - 12pmAfternoons = 12pm - 5pm
Check All That Apply
Monday Mornings
Monday Afternoons
Tuesday Mornings
Tuesday Afternoons
Wednesday Mornings
Wednesday Afternoons
Thursday Mornings
Thursday Afternoons
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