PeaceJam Video Internship Application
Email address
Name
Your answer
Birthday
MM
/
DD
/
YYYY
Social Security Number (for background check)
Your answer
Home Phone Number
Your answer
Mailing Address
Your answer
Currently Attending School?
Name of School
Your answer
Major
Your answer
Schedule Availability
Your answer
Are you currently employed?
Name of employer
Your answer
I, the undersigned, certify that all information provided on this application is accurate to the best of my knowledge. I understand that any misrepresentation on this statement will result in my immediate disqualification as a PeaceJam intern/volunteer. I understand that the PeaceJamFoundation will verify the information I have provided above.
Required
I give permission for PeaceJam Foundation staff to request a background check as part of the screening for entrance into this program. This may include verification of personal and employment references as well as a criminal check with the local authorities.
Required
I hereby release PeaceJam, the PeaceJam Board, and all providers of information, from any liability related to furnishing and receiving information related to arrests and convictions. Should any information in this application change, I agree to notify the program coordinator in writing within 30 days.
Required
Digital Signature of Applicant (Name)
Your answer
A copy of your responses will be emailed to the address you provided.
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