Authorization for Release of Information s4

MEMPHIS ZOO INTERNSHIP APPLICATION Fill out application and send completed application to: Volunteer Office, Memphis Zoo, 2000 Prentiss Place, Memphis, TN 38112, or [email protected]. For additional information, please call (901) 333-6654. Personal Information Last Name: Click here to enter text. First: Click here to enter text. Date: Click here to enter text. Street Address: Click here to enter text. Apt/Unit: Click here to enter text. City: Click here to enter text. State: Click here to enter text. Zip: Click here to enter text. Phone: Click here to enter text. Birthdate: Click here to enter Polo Shirt Size: Choose an item. text. SSN #: Click here to enter text. Email address: Click here to enter text. Have you ever been convicted of a If yes please explain: Click here to enter text. felony? ☐Yes ☐No

How did you hear about our internship program? Click here to enter text.

APPLICATIONS MUST BE COMPLETE, WITH A VALID GPA, BIRTHDATE, AND SOCIAL SECURITY NUMBER IN ORDER TO BE CONSIDERED. Please attach a resume and cover letter if you have one.

Experience/Education and Skills Education School Name and Last Year Major and Degree GPA Level Location Completed Click here to enter text. Click here to enter Click here to enter Click here High School text. text. to enter text. Click here to enter text. Click here to enter Click here to enter Click here College or text. text. to enter University text. Are you currently a full-time student? Current Employment Status: ☐ Yes ☐ No ☐ Full time ☐ Part-time ☐ Not Employed Current or most recent paid position held: Click here to enter text. Do you speak any other languages? ☐ Yes ☐ No Relevant Skills: Click here to enter text. If yes, please list language(s): Click here to enter text. ☐ Fluent ☐ Semi-fluent ☐ Basic Do you have any volunteer experience? ☐ Yes ☐ No If so, please provide the organization’s name, dates of service, and a description of volunteer work performed:Click here to enter text.

Availability Please check the season for which you are applying: ☐ Fall ☐ Spring ☐ Summer ☐ Other, please explain: Click here to enter text. Earliest Possible Start Date: Click here to enter a date. Latest Possible End Date: Click here to enter a date.

Please check Sunday Monday Tuesday Wednesday Thursday Friday Saturday your anticipated availability Morning ☐ ☐ ☐ ☐ ☐ ☐ ☐ Afternoon ☐ ☐ ☐ ☐ ☐ ☐ ☐ Evening ☐ ☐ ☐ ☐ ☐ ☐ ☐

Emergency Information Do you have any medical conditions that we should aware of in case of a medical emergency? Click here to enter text. Emergency Contact: Click here to enter text. Relationship: Click here to enter text. Phone Number (Day): Click here to enter text. (Evening): Click here to enter text.

Personal Information Why are you interested in an internship with the Memphis Zoo? Click here to enter text.

What specific experience would you like to gain through this internship? Click here to enter text.

Describe your long-term career goals: Click here to enter text.

Areas of Interest Please indicate which area interests you: Conservation and Birds and the Once Upon A Tropical Bird Large Hoofstock Research Bees Farm House and Birds ☐ ☐ ☐ ☐ ☐ Round Barn Horticulture Penguins Nutrition Center Hatchery ☐ ☐ ☐ ☐ ☐ IT Marketing Other: Click here to enter text. ☐ ☐

Personal/Professional References Name & Title Company & Address Telephone Click here to enter text. Click here to enter text. Click here to enter text. Click here to enter text. Click here to enter text. Click here to enter text. Click here to enter text. Click here to enter text. Click here to enter text.

Authorization for Release of Information

I understand that the information on my volunteer application is subject to checking and verification by Memphis Zoological Society doing business as the Memphis Zoo, and that my previous and present employers, organizations, and volunteer associations may be asked for information as to my character and record with them.

I hereby grant permission to the Memphis Zoological Society, doing business as the Memphis Zoo to contact these employers, organizations, and volunteer associations, and further, I hereby authorize my former and/or present employers, organizations, and volunteer associations to give any information as to my character and employment record with them.

I also grant permission to the Memphis Zoological Society doing business as the Memphis Zoo to obtain information from and/or copy police and court records in order to conduct a pre-volunteer investigation on me,

I hereby release from all liability and damages those individuals, companies, organizations, or agencies who provide information as stated above.

Should I become a volunteer, I agree to comply with all rules and regulations of Memphis Zoological Society doing business as the Memphis Zoo.

Signature Date: :