Internship Program

This is a pre-application for CareerSource Gulf Coast's Internship Program.

Applicants applying for the Internship Program must meet be able to complete a full-time internship for up to 12 weeks, meet eligibility requirements, and pass a background check and drug screen with the payroll entity.

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1. Contact Information

Full Name (First and Last Name) *

Middle Initial

Address *

Address 2

City/Town *

State/Province *

ZIP/Postal Code *

Email Address

Phone Number with Area Code *

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2. Are you registered on EmployFlorida.com, the state of Florida's workforce services website?

Yes

Unsure

If yes, what is your username?

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3. Enter the last four digits of your Social Security number. XXX-XX-

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4. What is your military status?

Active Duty

Veteran

N/A

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5. Which branch of the military are you serving in/did you serve in?

Army

Air Force

Navy

Marines

N/A

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6. Are you a military spouse?

Yes

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7. If you've taken any college-level classes/courses, please specify the type of training AND the date(s) you completed the course(s).

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8. Have you ever received training assistance from Workforce, Workforce Investment Act (WIA), or Workforce Innovation and Opportunity Act (WIOA) in the past?

Yes

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9. If "yes", what training assistance did you receive AND when did you receive it?

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10. Please indicate your marital status:

Single

Married

Domestic Partner

Divorced

Widowed

Separated

Other (please specify)

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11. Are you a citizen of the United State of America OR authorized to work in the USA?

Yes

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12. Please indicate your work status.

American citizen

Non-citizen with Work Visa

Non-citizen without Work Visa

Other (please specify)

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13. Are you available and able to complete a full-time internship (30-40 hours per week) during normal business hours for up to 12 weeks?

Yes

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14. What is your current employment status?

Employed

Unemployed

Other (please specify)

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15. Are you currently enrolled in training?

Yes, part-time student

Yes, full-time student

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16. How many people currently live in your household?

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17. What is your household's approximate annual income?

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18. What is your primary language?

English

Spanish

Creole

French

Chinese

Japanese

German

Arabic

Italian

Korean

Other (please specify)

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19. Do you have an understanding of the English language?

Yes

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20. At any time, have you ever been convicted of a felony?

Yes

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21. At any time, have you ever been convicted of a misdemeanor?

Yes

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22. Please check the following if you are currently receiving assistance:

Public assistance (Welfare Transition, TANF, etc.)

Food assistance benefits (SNAP)

Reemployment assistance (formerly UC)

FAFSA/Pell Grant (financial aid for secondary schooling)

N/A

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23. Please indicate your highest completed education level.

Less than High School Diploma

High School Diploma

GED

AA/AS Degree

BA/BS Degree

MA/MS Degree

PhD/Doctoral Degree

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24. Please enter the date you completed this level of education.

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25. Do you currently have a valid driver's license, reliable transportation, and car insurance?

Yes

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26. Which of the following driver's licenses do you hold?

Classes A, B, or C

Class D

Class E

CDL

N/A

Other (please specify)

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27. Do you have an occupational license?

Yes

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28. If yes, what type of occupational license do you have?

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29. Please list your last 3 employers, with the most recent being first.

Company name

Supervisor name

Supervisor contact information (phone number and email)

Position/title

Start Date
mm/yy

End date
mm/yy

Salary/hourly pay

Reason for leaving

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30. Please list your last 3 employers, with the most recent being first.

Company name

Supervisor name

Supervisor contact information (phone number and email)

Position/title

Beginning Date
mm/yy

End Date
mm/yy

Salary/hourly pay

Reason for leaving

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31. Please list your last 3 employers, with the most recent being first.

Company name

Supervisor name

Supervisor contact information (phone number and email)

Position/title

Beginning Date
mm/yy

End Date
mm/yy

Salary/hourly pay

Reason for leaving

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32. By typing your first and last name in the space below, you are indicating the information you have answered is correct to your knowledge.

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33. This Pre-Application in no way guarantees your acceptance as a participant under the CareerSource Gulf Coast's Internship Program. You will need to be placed on a waiting list upon submission of a satisfactory, completed form. CareerSource will review your submitted Pre-Application to determine your eligibility and may contact you to schedule an appointment. Please note that participation in the Internship Program may require you to enroll with a payroll entity that requires a background check and drug screen. Please notify this office of any changes in your contact information, or if you are no longer interested in the internship program.

By clicking the "I accept" box below, you are indicating that you understand the statement above.

I accept

NOTICE: Information you provide to this agency is CONFIDENTIAL. However, information obtained by this agency about you may be provided to other state or federal agencies in the performance of their official duties according to Federal and State Statutes.

An Equal Opportunity Employer/Program. Auxiliary aids and services are available upon request to individuals with disabilities. All voice telephones may be reached by persons using TTY equipment via the Florida Relay Services at 711.