| Date: |
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| Application For: |
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| How did you hear about this job: |
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Personal Information |
| First Name: |
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| Last Name: |
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| Middel Initial: |
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| Student ID Number: |
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| Street Address: |
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| City: |
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| State: |
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| Zip: |
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| Home Phone: |
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| Cell Phone: |
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| Email: |
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Educational History |
| Graduated From Highschool? |
Yes
No
GED
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| High School Name: |
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| Street Address: |
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| City: |
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| State: |
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How many semesters have you
attended Palomar College?: |
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| Units currently enrolled in: |
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| What is your major?: |
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| Have you attended any College, University or Trade School other than Palomar College?: |
Yes
No
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| College, University, Trade School Address: |
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| City: |
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| State: |
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| Degree/Certificate: |
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| College, University, Trade School Address: |
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| City: |
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| State: |
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| Degree/Certificate: |
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Experience |
| What RTV courses have you completed?: |
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| What RTV courses are you currently enrolled in?: |
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| Do you have any other production related experience?: |
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| Why are you interested in interning with us?: |
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Current and past employment |
| Start Date: |
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| End Date: |
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| Employer: |
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| Address: |
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| Phone: |
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| Supervisor: |
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| Job Title: |
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| Describe duties and responsibilities: |
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| Start Date: |
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| End Date: |
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| Employer: |
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| Address: |
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| Phone: |
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| Supervisor: |
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| Job Title: |
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| Describe duties and responsibilities: |
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May we contact your present
and past employers?: |
Yes
No
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Personal References (only one may be relatives) |
Personal Reference 1 |
| Name: |
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| City: |
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| State: |
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| Phone: |
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| Relationship: |
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Personal Reference 2 |
| Name: |
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| City: |
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| State: |
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| Phone: |
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| Relationship: |
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Personal Reference 3 |
| Name: |
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| City: |
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| State: |
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| Phone: |
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| Relationship: |
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Days and hours available to work |
| Monday: |
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| Tuesday: |
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| Wednesday: |
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| Thursday: |
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| Friday: |
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| Saturday: |
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Do you have any physical condition that may limit your ability to perform the duties of the position applied for?
If yes, please explain: |
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Additional Information or comments: |
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