Summer Intern Application | South Dakota Farmers Union

Name*
First Last
Address*
Street Address Address Line 2 City State ZIP Code
Email
Phone
When is the best time to reach you?
Are you at least 19 years old?
- Yes
- No
Do you have a Valid Drivers License?
- Yes
- No
Have you ever been convicted of a felony?
- Yes
- No
Have you ever been convicted of a DWI, DUI, Minor Consumption or other misdemeanor?
- Yes
- No
Please describe your qualifications, activities, experiences and skills which you feel would contribute to your ability as a Farmers Union summer staff/intern.
Please describe briefly activities you have been involved in (school, church, community, etc.)
Please briefly describe your career goals and interests
Please describe any recreational hobbies you enjoy.

Father's Name
First Last
Father's Address
Street Address Address Line 2 City State ZIP Code
Mother's Name
First Last
Mother's Address
Street Address Address Line 2 City State ZIP Code
Person to notify in case of emergency
First Last
Phone
Address
Street Address Address Line 2 City State ZIP Code
Do you have a disability that would require reasonable accommodations?
- Yes
- No
If yes, please specify

Previous Employment
Start with your present or most recent job. Include military service assignments and volunteer activities. You may exclude organization names which indicate race, color, religion, gender, national origin, disability or other protected status.
Employer
Address
Street Address Address Line 2 City State ZIP Code
Phone
Job Title
Supervisor
Date Started
Date Ended
Reason for Leaving
Hourly/Rate Salary
Work Performed
Employer
Address
Street Address Address Line 2 City State ZIP Code
Phone
Job title
Supervisor
Date Started
Date Ended
Reason for Leaving
Hourly Rate/ Salary
Work Performed

References
Please list three names, addresses and phone numbers of adults who know you well in your home community, church, high school, college, Farmers Union or other important areas of your life. No relatives or former employers please.
Name
First Last
Address
Street Address Address Line 2 City State ZIP Code
Phone
Job Title
Name
First Last
Address
Street Address Address Line 2 City State ZIP Code
Phone
Job Title
Name
First Last
Address
Street Address Address Line 2 City State ZIP Code
Phone
Job Title

Summer Staff/Intern Application