CONGRESSIONAL INTERNSHIP APPLICATION

U.S. Congressman Chuck Fleischmann

Third District, Tennessee

Please fill out the form in the space provided, sign the disclosure agreement, save it as a doc file, enclose a copy of your resume, and email it

Name:Phone #:

Birthday (M/D/Y): Social Security #:

Have you resided in the district? If so, how long:

Home Address:

Email:

University:

Year: Email:

Major/Minor:GPA:

High School:Year:

Prior Internship Experience:

Name of Intern Coordinator:Phone Number:

Will you receivecollege credit for this internship? (Circle one) Yes/No

Days & Times of the week available for Internship:

Day / Monday / Tuesday / Wednesday / Thursday / Friday
Time Available

List any specific dates you are unable to work during the Internship:

Where would you like to Intern? (Circle one)Washington, D.C.Chattanooga

Athens Oak Ridge

Short Answer Question:attach word document with your short answers

  1. List the names of any campus organizations to which you belong, the positions you have held in each, if any:
  1. List the major non-campus, civic, social, or political activities in which you have participated in the last five years. What do you consider to be your most significant contribution to these organizations? Why?
  1. Describe any jobs you have held over the last five years and how these experiences would prepare you to work in Congressman Fleischmann’s office:
  1. Explain why you want to be an intern for Congressman Fleischmann. What do you consider to be your major strengths and qualifications for the program? What benefits do you feel are likely to result from your participation?
  1. Please list two references and include name, address, phone number, and affiliation with that person:
  1. What experience are you hoping to gain from this internship?
  1. Do you plan to pursue a job on the Hill following the internship?
  1. How would you describe your work ethic?

Below are a number of countries, organizations, people, and publications involved in public policy. For those you recognize, place: A plus (+) in front of those you agree with on most issues, a minus (-) in from of those you disagree with on most issues, a zero (0) in front of those you know, but have no strong feelings about, and leave BLANK those you do not know.

1

___ AFL-CIO

___American Civil

Liberties Union

___ Americans for Democratic Action

___Amnesty International

___ Brookings Institution

___ Brady Campaign

___ CATO Institution

___Common Cause

___ CNN

___ Empower America

___ English First

___Family Research Council

___ Family Research Council

___ Fox News

___ George W. Bush

___ George Soros

___ Greenpeace

___Heritage Foundation

___Hillary Clinton

___ Jon Stewart

___Keystone XL Pipeline

___ Milton Friedman

___ MSNBC

___ Nancy Pelosi

___ National Education Assoc

___ NAFTA

___ National Organization of Women

___National Review Magazine

___ National Rifle Association

___ National Right to Work Committee

___North American Treaty Organization

___ OSHA

___Paul Ryan

___Planned Parenthood

___ President Donald Trump

___Rand Paul

___ Ronald Reagan

___ Rush Limbaugh

___ Russia

___ Sierra Club

___Tea Party

___ The United Nations

___ U.S. Chamber of Commerce

___ World Bank

___World Trade Organization

1

By completing and signing this application for internship, I hereby certify that all information submitted is truthful. I give the Office of Rep. Chuck Fleischmann authorization to contact prior employers for references and to conduct a criminal background check. I understand that submitting false information on this application or any prior criminal offense can be grounds for denial of an internship offer, revocation of an offer, or immediate dismissal from employment.

______

SignatureDate Print Full Name

1