RecTech Summer Internship 2011

Application To respond, select your answers from the available choices. Thank you. Name text here ______________________________________________ Address text here ______________________________________________ City text here ______________________________________________ State text here ______________________________________________ Zip text here ______________________________________________ Main phone number text here ______________________________________________ Secondary phone number text here ______________________________________________ email text here ______________________________________________ Date of Birth text here ______________________________________________ Name(s) of parents/guardians text here ______________________________________________ Date of Birth text here ______________________________________________ Address of parents/guardians text here ______________________________________________ parents/guardians primary phone # text here ______________________________________________ Parents/guardians Secondary phone # text here ______________________________________________ Parents/guardians email text here ______________________________________________ First choice? web video photo Don't Know/Not Applicable ______________________________________________ Second choice? web video photo Don't Know/Not Applicable ______________________________________________ Third choice? web video photo Don't Know/Not Applicable ______________________________________________ Name of school text here ______________________________________________ Grade text here ______________________________________________ Expected year of gradustion text here ______________________________________________ Languages spoken text here ______________________________________________ Please list your previous work and/or volunteer experience most recent Employer name text here ______________________________________________ Position text here ______________________________________________ Dates of employment text here ______________________________________________ Contact info text here ______________________________________________ most recent but one Employer name text here ______________________________________________ Position text here ______________________________________________ Dates of employment text here ______________________________________________ Contact info text here ______________________________________________ most recent but two Employer name text here ______________________________________________ Position text here ______________________________________________ Dates of employment text here ______________________________________________ Contact info text here ______________________________________________ Do you currently have a job? Yes No Don't Know/Not Applicable ______________________________________________ If yes, please provide name, location and schedule of your current job: text here ______________________________________________ Do you want to go to college? Yes No Don't Know/Not Applicable ______________________________________________ If yes, where do you hope to apply to college? text here ______________________________________________ What careers are you interested in? text here ______________________________________________ How do you think the RecTech Summer Internship will assist you in reaching your future goals? text here ______________________________________________ TECHNOLOGY Please rate your ability to use computers? High Medium Low Not at all Don't Know/Not Applicable ______________________________________________ Have you ever taken a technology course or training before? Yes No Don't Know/Not Applicable ______________________________________________ Course name text here ______________________________________________ school or location name text here ______________________________________________ Do you have a computer at home? Yes No Don't Know/Not Applicable ______________________________________________ Do you have Internet access at home? Yes No Don't Know/Not Applicable ______________________________________________ How often do you use a computer? Daily 3 times per week Once a week Not at all Don't Know/Not Applicable ______________________________________________ How often do you surf the web? Daily 3 times per week Once a week Not at all Don't Know/Not Applicable ______________________________________________ SPECIFIC TECHNOLOGY SKILLS Internet High Medium Low Not at all Don't Know/Not Applicable ______________________________________________ E-mail High Medium Low Not at all Don't Know/Not Applicable ______________________________________________ Instant messaging High Medium Low Not at all Don't Know/Not Applicable ______________________________________________ Microsoft Office High Medium Low Not at all Don't Know/Not Applicable ______________________________________________ Web Design High Medium Low Not at all Don't Know/Not Applicable ______________________________________________ Digital Media High Medium Low Not at all Don't Know/Not Applicable ______________________________________________ Graphics High Medium Low Not at all Don't Know/Not Applicable ______________________________________________ PDA/handhelds High Medium Low Not at all Don't Know/Not Applicable ______________________________________________ Wiring and cabling for networks High Medium Low Not at all Don't Know/Not Applicable ______________________________________________ Software installation High Medium Low Not at all Don't Know/Not Applicable ______________________________________________ PC trobleshooting High Medium Low Not at all Don't Know/Not Applicable ______________________________________________ Network administration High Medium Low Not at all Don't Know/Not Applicable ______________________________________________ Blogs, podcasting High Medium Low Not at all Don't Know/Not Applicable ______________________________________________ What are your future goals? text here ______________________________________________ Why should we hire you at RecTech? text here ______________________________________________ If you had $500.00 to spend, what would you do with it? text here ______________________________________________