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2. Please read the following instructions before completing:
   Review the Minimum Qualifications on the job announcement. If applying for more than one internship, a separate application is required for each.
4. How did you learn about this vacancy?*
   -- Select One --Walk-inReferred by City EmployeePatterson IrrigatorModesto BeeCity of Patterson WebsiteOther
5. Title of Position*
7. Last Name*
8. First & Middle Name*
10. Address1*
12. Address2
14. City*
15. State*
16. Zip*
18. Driver's License:
19. Number
20. Issuing State
21. Expiration Date
23. Do you have a driver's license and use of a vehicle?*
    -- Select One --YesNoLicense Only
24. Check One*
    -- Select One --FreshmanSophomoreJuniorSeniorOther
25. Semester*
    -- Select One --FallWinterSpringSummer
26. GPA*
28. Graduation Date*
32. School Information:
33. College or University*
35. Address*
37. Contact*
38. Phone Number*
42. Employer
43. Address
45. From
46. To
47. Supervisor Name and Title
49. Description of Duties
53. Employer
54. Address
56. From
57. To
58. Supervisor's Name & Title
60. Description of Duties
64. Employer
65. Address
67. From
68. To
69. Supervisor's Name & Title
71. Description of Duties
75. Skills and Training
77. Skills, Abilities and Interests:*
79. Computer:*
81. What foreign languages do you speak and understand?
83. Other valid licesnes and/or certificates you hold that relate to your qualifications for this position:
85. When are you available to start a work-study/internship?*
86. Approximate hours per week:*
88. What are your objectives for participating in an internship program?*
90. What kinds of work would you like to do during your internship?*
92. Internship Preference*

    1. Generalist
    2. Specialist
93. Specialist - area of Interest
95. If a stipend is not offered, would you be able to accept an internship on a volunteer basis?*
97. What, if any, limitations do you have that may have a bearing on your placement?
99. Certificate of Application
    I certify that all of the statements made on this application are true, complete and correct to the best of my knowledge and belief and are made in good faith. I understand that any false or omitted information, which I may or may not give, may result in either denial of internship or termination. I authorize the City of Patterson to investigate all statements on this application, including work references. I acknowledge that this internship is conditional upon successful completion of a physical examination and/or drug screening test, and a background check as part of the City's pre-employment policy.
101. Certify*

     1. I certify that I have read, understand, and agree to the above.
103. Consent
     It is the City's policy, as a part of the selection process, to contact your former employers for employment-related reference information. If you refuse to authorize us to contact all but your present employer, you will be disqualified from consideration for the position. Employers will be contacted only if you have met all other qualifications and you are actually being considered for employment.
105. Consent*

     1. I hereby authorize my former employers to release employment-related information to the City of Patterson.
Leave This Blank:


107. 1. Receive an email copy of this form.
108. Email address

     This field is not part of the form submission.

109. Submit Submit and Print

* indicates a required field