Personal Information:
Your Name:
E-mail address:
Address:
No P.O. boxes please
City/St/Zip
Hm Phone:
Cell:
Date
of Birth:
Who can we call in case of an emergency?
Their phone number:
Medical Insurance carrier:
Do you have a valid driver's license?
YES NO
Personal reference (non-relative
only):
Name:
Phone:
Education/Professional
Information:
Place of employment (if applicable):
School/university:
Year: Freshman
Sophomore
Junior Senior
Graduate School
Your major:
Educational Reference #1:
Name:
Phone:
Educational Reference #2:
Name:
Phone:
Internship
Information:
You may be lifting animals, feed bags, or hay or straw of 50 lbs or perhaps
more.
Do you have an physical limitations that may limit the work you may be
asked to do on the farm? YES
NO If yes,
please explain:
Do you suffer from back pain?
YES NO
Are you allergic to any animals?
YES NO
Do
you smoke?
YES
NO
Why do you want to intern at Pasado's Safe Haven?
Are you afraid of any animals such as birds or dogs?
YES NO
If yes, please explain:
Interns are asked to do just about anything and everything
to help us
support the animals. This can mean helping in the
office writing out envelopes
to scooping poop. Would you have
a problem with this?
YES NO
Have you ever been a plaintiff in a lawsuit?
YES
NO If yes,
please explain:
Pasado internships are
unpaid. Are you capable of paying for your own living expenses for a
three-month period?
YES
NO
(If living on-site, living quarters are provided at no charge to
interns.)
What other information would be helpful to us in getting
to know you better?
Are you a vegan? YES
NO
Vegetarian? YES
NO
Those who work for Pasado's Safe Haven do not
practice "selective compassion". Therefore Pasado's sanctuary is an
"animal product-free" zone. If you were accepted as our intern, and
while you lived on-site at the sanctuary, would you have a problem
with not eating animal products?
No, not at all
Yes, I would not want to live a vegan life-style.
Pasado I nternships require a 3-month commitment. You also live on-site
at Pasado's Safe Haven. Confirm that these arrangements are
amenable to you:
YES - I
can commit to a solid 3-month commitment
and would love to live on-site at Pasado's!
NO - I'm
afraid I may not be able to commit.
I am applying for the following internship dates: (Choose one only):
Summer Apr or May through August
Fall September through November
Winter Beginning Nov., Dec., Jan., or
Feb .
Please note exact dates that you can serve:
From
To: