Please copy this application onto a google doc or email or word doc, and email the completed application, along with a current photo of yourself, to Patricia Mikkelson at livablefutureproject at gmail.com Contact me if there are any questions.
Email completed application to livablefutureproject@gmail.com
Application Date:
Name:
Address:
State/Province:
Zip/Postal Code:
City:
Email Home
Phone:
Cell Phone:
Please explain why you would like to do an internship program?
What specific experience, formal or informal, do you have with working and living with others, living off grid and/or living in community.
Emergency Contact Person and Phone:
What dates are you hoping to come?
Have you ever been convicted of a crime: yes no
If yes, please explain
Do you have a driver’s license? yes no
State of issue:
Have you had any accidents in the past 3 years? yes no
How many?
Have you had any moving violations in the past 3 years? yes no
How many?
Previous Employment (list up to 3)
1. Name of Employer:
Name of last supervisor:
Dates of employment: From: To:
Salary: From: To:
Complete Address:
Phone #:
Last job title:
Reason for Leaving (be specific):
List the jobs you held, duties performed, skills used or learned, advancements, or promotions while you worked at this company:
May we contact your employer: yes no
2. Name of Employer:
Name of last supervisor:
Dates of employment: From: To:
Salary: From: To:
Complete Address:
Phone #:
Last job title:
Reason for Leaving (be specific):
List the jobs you held, duties performed, skills used or learned, advancements, or promotions while you worked at this company:
May we contact your employer: yes no
3. Name of Employer:
Name of last supervisor:
Dates of employment: From: To:
Salary: From: To:
Complete Address:
Phone #:
Last job title:
Reason for Leaving (be specific):
List the jobs you held, duties performed, skills used or learned, advancements, or promotions while you worked at this company:
May we contact your employer: yes no
Hobbies/passions:
List any Allergies (Food or Environmental).
Are you willing to eat a plant-based diet while on the community land?
Do you understand that there is no smoking, using illegal drugs or drinking on the community land?
Are you willing to keep these simple agreements:
I will treat others with respect.
I will learn and follow the conflict resolution guidelines.
I will aspire to live with integrity and courage.
I will work the number of hours I commit to.
Please provide 2 references who are other than family or previous employers.
Name:
Company:
Position:
Phone number:
Use this space to add any additional information necessary to describe information about yourself that helps me to understand why you would like to do an internship and what you would like to get out of the program.
