Applicant Information Last Name First Name M.I. Date Street Address Apartment/Unit # City State Zip Code Contact Number Contact Email I am applying for the: (select one) Fall Semester Spring Semester Summer Semester Date Beginning: I am applying for an internship in the: (select one) Ventura District Office Santa Barbara District Office Have you ever worked for a State or Federal office? Yes No If yes, when? Education High School: Address: From From: To: Did you graduate? Yes No Diploma: To: College: Address From: To: Did you graduate? Yes No Degree: Other: Address From: To: Did you graduate? Yes No Degree: References Please list two professional references. Reference 1 Full Name: Relationship: Phone: Company: Address: Reference 2 Full Name: Relationship: Phone: Company: Address: Disclaimer and Signature I certify that my answers are true and complete to the best of my knowledge. Signature Sign above Date Leave this field blank