Insert Program Name Here

Internship/Volunteer Agreement

{Insert Program Name Here}

____Intern ____Volunteer Name: ______

Expected Duration of the Intern/Volunteer Assignment: From ______To ______

(Date) (Date)

Intern or Volunteer Scope of Responsibilities: {Insert an overview of the internship or volunteer responsibilities}

Supervised by: {Insert the Name and Title of person providing supervision}

Duties assigned: {Insert a list of responsibilities}

Application: Any individual interested in an internship or volunteer opportunity with BAMSI must complete an online application by visiting the BAMSI career site and clicking the “Submit Profile” tab.

CORI: Any individual interested in an internship or volunteer opportunity with BAMSI must complete a CORI consent form prior to beginning the assignment. Managers may not allow an intern or volunteer to begin until HR has approved the CORI results.

Driving Record Authorization: Any individual who will be driving as part of their internship or volunteer assignment with BAMSI must complete a Driving Record Authorization form prior to beginning the assignment. Managers may not allow an intern or volunteer to drive during their scheduled hours until HR has approved the driving results.

Orientation: Interns and volunteers must complete BAMSI’s Self Teaching Packet upon starting an assignment. The self teaching packet shall serve as the minimum orientation for all interns and volunteers at BAMSI. Interns and volunteers may receive additional orientation and training at the program related specifically to their assignment.

Confidentiality Agreement: Interns and volunteers must complete the agency’s Confidentiality Agreement upon starting an assignment with BAMSI.

Termination of Assignment/Dismissal: Intern/Volunteer termination of assignment/dismissal shall be in accordance with the plan established at the time of assignment or at the discretion of the designated supervisor. The supervisor shall consider program staffing needs, his or her ability to provide supervision, and intern/volunteer performance when making a decision to dismiss an intern or volunteer prior to the scheduled end date of an internship or volunteer assignment.

Signature of Intern or Volunteer: ______

Printed Name: ______

Date: ______

Signature of Person Providing Supervision: ______

Printed Name: ______

Date: ______

Upon completion of an intern or volunteer assignment, the supervising manager will complete the following section of this form and send to Human Resources:

Intern or Volunteer Name: ______

Last Day of Work: ______

Would you recommend this intern or volunteer for hire with BAMSI?

Yes ______No ______

Comments: ______

______

Please use the checklist below upon completion of the intern or volunteer assignment and check all that apply:

____ Recover keys (buildings, office, desks, files)

____ Recover computer equipment including peripherals, files, and software

____ Recover cell phone (including chargers, case, hands-free equipment, etc.) if provided

____ Recover employee ID and/or other BAMSI identification

____ Recover tax-exempt card, cash, receipts, reimbursement form, if applicable

____ Recover files, office supplies, other BAMSI property

____ Notification, as needed, to other BAMSI programs/departments/persons served

____ Notification, as needed, to outside agencies or organizations

____ Arrange removal of personal belongings from workplace

Supervisor’s signature: ______

Date: ______

4/4/11