Northwest Missouri State University

Application for Internship In the Library and/the CITE Office
Date of Application: Personal Data: Name: (Last) Local Address: (Street) Local Phone: Secondary Address: (Street) Secondary Phone: Internship Faculty Advisor: Major: Year in School: Minor: Freshman Sophomore (City) (State) Primary Email Address: (Zip) (First) (Nickname) (Middle) Northwest Network Username: 919 #:

(City)

(State) Secondary Email Address: Advisor’s Phone Number: Other Work: Junior Senior

(Zip)

Graduate

Expected Date of Graduation: Proposed Internship Time Period: (choose from dropdown list) Trimester: Fall Credit Hours of Internship 1 = 50 actual hours Start Date: End Date:

Please add a check in the times you are unavailable to work. 8:00
Mon

9:00

10:00

11:00

12:00

1:00

2:00

3:00

4:00

Tue

Wed

Thur

Fri

Software and Programming:
Please rate your ability on each of the listed software packages and scripting/programming languages by entering the number that best describes your ability/experience. The default rating is 0 – ‘No knowledge of’. If you have experience in other software or programming languages, please enter those and rate yourself.

0 – No knowledge of 1 – Beginners knowledge but no experience 2 – Beginners knowledge and have experimented with 3 – Average knowledge and have experience working with on a limited basis 4 – Knowledgeable of most aspects and used often 5 --Thorough knowledge of and can teach others how to use.

Software: Adobe Flash Adobe Dreamweaver Adobe Illustrator Adobe InDesign Adobe Photoshop Adobe Fireworks Adobe Captivate Adobe Premiere Camtasia Final Cut Pro I-Movie I-DVD Other Software Packages: Name: Name:

0 0 0 0 0 0 0 0 0 0 0 0

0 0

Programming and Scripting Languages HTML 0 CSS 0 XML 0 Java Script 0 Action Script 0 C++ 0 Java 0 Visual Basic .Net 0 ASP .Net 0 C# 0 SQL 0 Perl 0 Other Programming or Scripting Language Name: 0 Name: 0

A digital resume is also welcomed but not mandatory as a part of this application.
PLEASE READ CAREFULLY - By inserting my name (as written above) in the text field below, I certify that the above statements are correct. I understand that any false information (or omissions) in the application, or its supporting documents, will be sufficient grounds for refusal to hire me or termination without notice. I agree that all rules, orders, and regulations of the Board of Regents affecting my employment shall constitute a part of my appointment or employment. I further understand that Northwest Missouri State University has the right to review my education, previous employment, driving and criminal records and other background data. Please re-type your name here (this is a proxy for your signature): Date (MM/DD/YYYY):

Northwest Missouri State University is an equal opportunity employer.

Once you have this application filled out, please email it to both supervisors below: Lori Mardis, Information Librarian/Assistant Professor Northwest Missouri State University B.D. Owens Library 800 University Drive, Rm 132 Maryville, Missouri 64468-6001 PHONE 660-562-1393 FAX 660-562-1049 mailto:lmardis@nwmissouri.edu Jolaine Zweifel, Computer Software Specialist Center for Information Technology in Education Northwest Missouri State University B.D. Owens Library, Rm 246 Maryville, Missouri 64468-6001 Phone: 660-562-1532 mailto:zweifel@nwmissouri.edu

Applications will be acknowledged with a reply email. Interviews scheduled will be with both Lori and Jolaine.

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