<p> EMBASSY OF AUSTRALIA Washington DC INTERNSHIP APPLICATION FORM</p><p>To complete this form on-line, use the Tab button to move to each data field. Complete check boxes by inserting ‘x’ or using the Space Bar. 1. Personal Particulars Title Surname Given Name(s)</p><p>Work Number (incl. Area Code) Postal Address</p><p>Home Number (incl. Area Code) City, Suburb or Town, Country State Postcode/Zip</p><p>Other Number (eg Mobile) Email Address</p><p>Do you have authorisation to work in the United Note: Internships are unpaid. International applicants must have an A1 or A2 visa, Greencard or States? YES NO INS work authorisation in order to intern at the embassy in Washington, DC. Citizenship </p><p>2. Availabilty Please state the semester you are applying to intern, as well as the days and times you would be available to intern.</p><p>SPRING SUMMER FALL DAYS AND TIMES AVAILABLE:</p><p>3. Referees (Please provide the names of two referees who we can contact) Referee’s Name/Company Referee’s Name/Company</p><p>Referee’s Relationship to Applicant/Years of relationship Referee’s Relationship to Applicant/Years of relationship</p><p>Contact Number Contact Number</p><p>4. Fit and Proper Person It is a requirement of employment that Embassy staff be seen to be ‘fit and proper’ persons. Have you ever been criminally convicted? If yes, provide details. </p><p>NO YES If Yes, provide details</p><p>5. Personal Statement Please provide a brief statement explaining your interest in an internship at the Australian Embassy. If you need additional space, please attach an additional page.</p><p>6. Applicant’s Statement The above information, to the best of my knowledge, is true and correct. I consent to the Embassy collecting and using information, and to relevant employers disclosing information, in relation to my work performance and conduct for the purpose of assessing my suitability to carry out the duties of the job I have applied for, and suitability for employment to become an Embassy intern. I understand that misstatements or omissions in the selection process may result in a failure to hire or immediate discharge if they are discovered.</p><p>Signature or tick box if completing form electronically Date</p>