Internship (Geriatrics - New York City Metro Area)

Job Code: 1734750 Location: Manhattan

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1. General Information

* FIRST NAME	M.I.	* LAST NAME

* HOME PHONE (xxx)xxx-xxxx	WORK PHONE (xxx)xxx-xxxx

* EMAIL

* ADDRESS

* CITY	* STATE/PROVINCE	* POSTAL CODE

* COUNTRY

2. Questionnaire

1. HAVE YOU EVER APPLIED FOR EMPLOYMENT WITH YAI OR ANY OF ITS AFFILIATES? *

Yes
No

2. IF YES, PLEASE INDICATE WHEN, THE NAME OF THE PROGRAM AND THE NAME OF YOUR SUPERVISOR.

3. ARE YOU 18YRS OF AGE OR OLDER? *

Yes
No

4. WHAT IS THE HIGHEST LEVEL OF EDUCATION YOU HAVE ACHIEVED? *

5. DO YOU POSSES A VALID NYS DRIVER'S LICENSE? *

Yes
No

6. DO YOU WANT TO WORK DIRECTLY WITH INDIVIDUALS WITH DISABILITIES? IF NOT, WHAT TYPE OF WORK ARE YOU INTERESTED IN DOING? *

7. IS THIS INTERNSHIP FOR SCHOOL CREDIT OR FOR YOUR OWN EXPERIENCE? *

8. IF FOR SCHOOL CREDIT, WHAT ARE THE SCHOOL REQUIREMENTS? (I.E. DEGREE OF YOUR POTENTIAL SUPERVISOR, # OF HOURS TO BE COMPLETED, INTERNSHIP DUTIES, ETC.)

9. FOR WHAT LENGTH OF TIME ARE YOU INTERESTED IN DOING THIS INTERNSHIP? (I.E. 1 SEMESTER, 3 MONTHS, ETC.) *

10. OUR INTERNSHIPS ARE UNPAID. ARE YOU OPEN TO AN UNPAID INTERNSHIP? IF NOT, PLEASE REFER TO PAID POSITIONS. *

Yes
No

11. HOW DID YOU HEAR ABOUT THE INTERNSHIP OPPORTUNITY? *

12. WHAT GEOGRAPHIC LOCATIONS ARE YOU INTERESTED IN? PLEASE MARK IN ORDER OF PREFERENCE *

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13. WHAT ARE YOUR CAREER GOALS? *

14. PLEASE DESCRIBE BRIEFLY WHAT MENTAL RETARDATION IS. *

15. WHAT EVERYDAY ACTIVITIES DO INDIVIDUALS WITH MENTAL RETARDATION NEED ASSISTANCE WITH THAT WE TAKE FOR GRANTED? *

16. WHAT IS THE PURPOSE OF TEACHING SKILLS TO THIS POPULATION? *

17. IS THERE A SPECIFIC EXPERIENCE YOU WOULD LIKE TO GET OUT OF THIS INTERNSHIP? *

18. DO YOU HAVE ANY CONCERNS ABOUT WORKING WITH THIS POPULATION?

19. MOST OF OUR INTERNSHIPS ARE WORKING WITH ADULTS. DO YOU WANT TO WORK WITH ADULTS OR CHILDREN? *

20. WHAT DAYS AND HOURS ARE YOU AVAILABLE? *

3. Resume or Profile

* PLEASE PASTE A COPY OF YOUR RESUME OR PROFILE BELOW.

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