The Dallas Environmental Education Initiative (EEI) is proud to offer a paid ($1,200) summer internship opportunity to Dallas junior and senior high school students at least 17 years of age. EEI summer interns will work collaborately with staff and faculty at both Dallas City Hall & UNT from June 11 – July 31 (Monday – Wednesday, excluding the week of July 4th). Through this program, EEI interns will gain job experience in environmental science research, and build on their college and professional skills.

Submit your application online to Dr. Ruthanne “Rudi” Thompson at:

The application deadline is:

May 11, 2012


Use of Data

Purpose: The purpose of this form is to tell you how we may use the information from your application and participation in this program. It also tells with whom we might share this information and what will happen if you choose not to provide it.

Program Information

·  Why we are asking for the information: To help us decide whether you are eligible for the program and what other services you may need to become self-sufficient.

·  How we plan to use the information: We may use it to prepare required reports, conduct audits, review eligibility, and to find out how the program is helping you.

·  With whom we may share this information: With staff, for purposes of performing their official duties with the City of Dallas.

·  Providing false information can lead to removal from the program.

Funding for the EEI Summer Internship Program is provided by the City of Dallas Water Conservation and Recycling Division.

If you need assistance completing this application,

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1.  Your Name

First: ______Middle: ______

Last: ______

2. Your age on June 1, 2012______

*Eligible applicants must be between the ages of 17-19 on June 1, 2012

3. School Information

Name of school you are attending: ______

Current grade level: ______11th ______12th (check one)

Student ID number: ______

4. Your Address

Street Address: ______Apt # ______

City: ______State: ______Zip: ______

*Eligible applicants must live in the city of Dallas

5. Contact Information

Home Phone:______Cell Phone: ______

Other Phone: ______

Email Address: ______

6. Work Eligibility

Social Security Number: ______

Date of Birth: ______/______/______(month/date/year)

Eligibility to Work (check one):

______U.S. citizen

______Non-citizen, eligible to work in the U.S. (must provide I-94#):______

1. What organized activities do you participate in? (Check all that apply)

______Admission Possible ______Upward Bound ______Sports Team

______National Honor Society ______Student Newspaper ______School Club

______Student Government ______Other: ______

2.  Work/Volunteer Experience

List employment or volunteer experiences

Employer / Job Title / Dates / Paid or Unpaid / Duties

Describe the skills you gained from your volunteer or work experiences:

______

3.  Skills/Assets:

I can use the following computer programs:

With Help Without Help Don’t Know

Word ______

Excel ______

PowerPoint ______

Describe any other computer or technology skills you have:______

1. How would you handle the following situation?

You are scheduled to start work at 8:00am. You usually get a ride to work with your friend who works at a job near yours. Your friend calls at 7:45am saying he/she overslept and is not going to work today because he/she is sick.

______

2. What skills do you have that make you a good candidate for a summer job with UNT:

______

3. What type of job would you like this summer and what skills do you hope to gain from that job?

______

All youth under 18 must have parent/guardian permission to participate in EEI. The parent/guardian must read and complete al sections on this page. If you are currently 18, you may complete this section yourself.

Youth (Applicant) Name: ______Phone: ______

Parent/Guardian Name: ______Phone: ______

Emergency Contact Name: ______Phone: ______

Does your child have a special need or health condition that may affect their worksite assignment or participation in EEI? ______yes ______no

If yes, please explain:______

Parent Permission Statement

·  I hereby give my permission for my child to participate in EEI activities that may lead to employment and training opportunities.

·  I voluntarily release the City of Dallas and UNT from any and all liability based on claimed negligence at times when the youth participant is not under the supervision of the aforementioned parties.

·  I further state that I have read this application and that it is accurate and complete to the best of my knowledge.

·  I agree to provide, if requested, any documentation necessary to verify information on this form and I authorize the City of Dallas and UNT or their providers to verify information provided, if necessary.

·  I agree that EEI youth participants shall not claim any right to unemployment compensation resulting from any termination of employment or from any other event.

·  I agree that my child may be photographed and /or video recorded to promote EEI or his/her employer

·  I agree that my child may take part in program evaluations.

By signing below, I attest that I have read, understand, and agree with the information and statements within this application. Warning: Title 18, Part 1, Chapter 47, Section 1001 of the U.S. Code-Fraud and False Statements, makes it a criminal offense to make false statements or misrepresentations to any departments or agency of the U.S. as to matter within its jurisdictions.

Youth Signature: ______Date: ______(Required)

Parent Signature: ______Date: ______(Required)

Experience: Describe below any positions you have held in the recent past, or any other experience which you think may qualify you for a position. Include all previous employment with the State of Texas. Begin with your present or most recent employment.
Name of Employer Title of your position From (date)
Address Employer Tel. No. Hourly Wage To (date)
Duties
Name of Employer Title of your position From (date)
Address Employer Tel. No. Hourly Wage To (date)
Duties
Equal Employment Opportunity Information: This program is attempting to monitor recruitment and selection in order to assure equal employment opportunity. We would appreciate your cooperating by voluntarily furnishing us with the information requested below. The information will be kept confidential and used only for affirmative action purposes.(check all the apply)
____ Male ___ Black ___ American Indian ___Asian American
___ Female ___White ___ Hispanic ___ Other Disabled ___
Certificate of Applicant: I hereby certify to the truth of all statements made in this application and agree that any false or misleading statements shall render null and void this application and any approval, appointment or other favorable action made in connection therewith.
Signature as is appears on front of application Date
My son/daughter has my permission to seek employment with the Summer Program.
Signature of Parent or Legal Guardian Date
Notice to all applicants: The number of summer jobs available is relatively small in comparison to the large number of applicants who file for summer employment consideration. Only a percentage of applicants are hired. Therefore, you should not limit your efforts to obtain summer work solely with the department of environmental management.
***********************STOP!! DO NOT WRITE I THE SPACE BELOW!!***********************
IF CANDIDATE IS HIRED, ALL POST-EMPLOYMENT INFORMATION BELOW MUST BE COMPLETED. If you have a disability and require an accommodation, please complete RI EOO-5/90A (self-identification form) available from RI EQUAL OPPORTUNTIY OFFICE or the RIDEM OFFICE OF HUMAN RESOURCES.
Your Social Security Number: ______- ______- ______Date of Birth: ______-______-______
Are you a United States citizen? ______yes ______no
I hereby certify to the truth of all statements made I this application and agree that any false or misleading statements shall render null and void this application and any approval, appointment, or other favorable action made in connection therewith.
______
Signature Date

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