Bethlehem Health Bureau
Internship Application
Created: May 1, 2016
PERSONAL INFORMATION
Last Name:
Apt #:
Zip Code:
E-mail Address:
First Name:
Home Address:
City:
State:
Phone Number:
EDUCATION
Major Area of Study/Degree:
Undergraduate Graduate
College/University:
Date of Graduation:
INTERNSHIP DETAILS
Semester Requesting Internship:
Fall Spring Summer
Internship Required Hours:
Requested Start Date:
Anticipated End Date:
Please submit the following with your application:
Resume
Documents confirming the completion of your background check
If accepted as an intern, I understand and agree that this opportunity is provided as an
unpaid internship. I further agree to abide by all rules and regulations set forth by the City
of Bethlehem.
Signature:
Date:
Electronic Signature is accepted
1) Criminal History Record Information obtained from the PA State Police, 2) Child Abuse Clearance obtained through
the PA Department of Public Welfare, 3)Federal Criminal History Record Information (Federal Background Check)
obtained by submitting a full set of fingerprints to the PA State Police or its authorized agent for submission to the
Federal Bureau of Investigation.
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