Forensic Consultation & Counseling Service, LLC
162 N. Main St. Suite 5
Rutland, VT 05701-3024
INTERNSHIP APPLICATION FORM
FCCS, LLC is an affirmative action/equal employment opportunity employer. Discrimination because of race, color, religion, sex, handicap, sexual orientation or national origin is prohibited.
In order to be considered for an internship, you must submit a signed and completed application form along with a cover letter and your resume and a photo identification.
All application items must be submitted as a complete package. Incomplete applications will not be reviewed.
Name(s) of Internship(s) Applied For:
Name:
School Name / Address:
Home Address:
School Telephone Number:
Home & Mobile Telephone Numbers:
Date of birth: Social Security Number:
Are you legally eligible to work in the U.S.? r Yes rNo: ______
Explain
If you are not a U.S. Citizen, are there any restrictions on your eligibility for employment?
Are you requesting that your college grant you credit hours for your internship? How Many?
Days / hours available to perform internship:
Mon. / Tues. / Weds. / Thurs. / Fri. / Sat. / Sun.Hours Available
What makes you interested in a position with FCCS, LLC?
Career goals:
Education:
Type of School Name and Location Degree/Date Major
High School
College(s)
Scholastic Honors and/or Social Activities:
Employment History (Includes paid, volunteer, and intern positions)
Most Recent Employer:
Telephone Number:
Address :
Supervisor (Name & Title):
Position Title: Start Date: End Date:
Description of duties:
Reason for leaving?
Employer:
Telephone Number:
Address :
Supervisor (Name & Title):
Position Title: Start Date: End Date:
Description of duties:
Reason for leaving?
Employer:
Telephone Number:
Address :
Supervisor (Name & Title):
Position Title: Start Date: End Date:
Description of duties:
Reason for leaving?
References
1. Name:
Telephone Number:
Company/School :
Relationship: Known how long:
2. Name:
Telephone Number:
Company/School:
Relationship: Known how long:
3. Name:
Telephone Number:
Company/School:
Relationship: Known how long:
Publications and Articles:
Community/professional organizations, honors and awards:
Activities relevant to the internship(s) for which you are applying:
Any criminal arrests / convictions? (Does not necessarily disqualify from employment) r No r Yes (explain)
I certify that all of the statements in this application are true and complete to the best of my knowledge. I
understand that a false or incomplete answer may be grounds for not considering me or for my dismissal.
Signature: Date:
INTERNSHIP PROGRAM INFORMATION
FCCS, LLC offers internships at its office in Rutland, VT and may require field work as assigned. The internship program is designed to provide students and recent graduates with an opportunity to learn about behavioral therapies and counseling and consulting various disorders.
Internship Positions Available: Internship opportunities are limited and require diverse skills including but not limited to administrative duties, client interactions, assisting therapists in duties, computer skills, paperwork filing, and form creation and utilization.
Eligibility: A candidate must be a graduate student; an undergraduate student; or have graduated from college within 6 months of beginning the internship.
General Information: Interns are expected to work between 20 and 40 hours a week during the internship period. Internships are offered during the Summer, Fall, and Winter/Spring semesters.
Interns may receive academic credit if an agreement is made between FCCS, LLC and the intern’s college or university. All interns are subject to the applicable FCCS, LLC
employee rules, and policies.
Application Procedures: Candidates must complete an application form and submit it with their cover letter and resume. Some internship positions require additional application items, such as a writing sample. All application items must be submitted as a complete package. Incomplete applications will not be reviewed.
Application Deadlines: Open until filled.
Mail, Email or Fax Applications to: FCCS, LLC
Attn: Internship Program
162 N. Main St. Box 5
Rutland, VT 05701-3024
Fax - (866) 639-9573 to attn: Internship
E-Mail:
Where to Go for Further Information:
FCCS, LLC web site - www.forensiccounselingservices.com
FCCS, LLC - (866) 639-9573 ext 707
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