C U R R E N T E M P L O Y M E N T V E R I F I C A T I O N F O R I N T E R N S H I P *Use this form to propose an internship WITH YOUR CURRENT EMPLOYER of more than 6 months. If proposing new job or promotion as internship (of less than 6 months), turn in your job description* STUDENT INFORMATION PLEASE TYPE ALL INFO RMATION IN THIS FORM – Name: Phone: Address: Student ID: Major: Specialty: Internship course selected : C U RR EN T EM PLO Y M EN T INFORMATION FILL OUT COMPLETELY! – Organization name: Current Supervisor name: Supervisor title: Current Department: Start Date: Address: City: State: Zip: Supervisor phone with extension: Supervisor e mail: Current position title: Hours per week: Current position duties: FILL OUT COMPLETELY! PROPOSED IN T ER N SHIP INFORMATION - Internship Position Title: Hours per week: Internship Supervisor name: Supervisor title: Internship Department: Address: City: State: Zip: Supervisor phone with extension: Supervisor e mail: Start date: End Date: Compensation: Primary Internship responsibilities (Major responsibilities, duties, expectations, etc. of the internship, including size and scope. Please be specific.): Secondary Internship responsibilities (Please note that administrative, coaching, etc. tasks can only comprise up to 30% of the internship duties): Internship Project(s): (Is a specific project with an expected outcome?): Internship Qualifications / Skills: (Degree(s) required or preferred / in progress, experience required, and/or expected or special skills): PLEASE READ BEFORE S IGNING You certify that your proposed internship meets the following criteria: It is in a different department than my permanent role I will be reporting to a different supervisor I will have substantially different responsibilities than my permanent employment role and the internship responsibilities are closely connected to my field of study at Davenport University
C U R R E N T E M P L O Y M E N T V E R I F I C A T I O N F O R I N T E R N S H I P *Use this form to propose an internship WITH YOUR CURRENT EMPLOYER of more than 6 months. If proposing new job or promotion as internship (of less than 6 months), turn in your job description* STUDENT INFORMATION – PLEASE TYPE ALL INFO RMATION IN THIS FORM Name: Phone: Address: Student ID: Major: Specialty: Internship course selected : C U RR EN T EM PLO Y M EN T INFORMATION – FILL OUT COMPLETELY! Organization name: Current Supervisor name: Supervisor title: Current Department: Start Date: Address: City: State: Zip: Supervisor phone with extension: Supervisor e mail: Current position title: Hours per week: Current position duties: PROPOSED IN T ER N SHIP INFORMATION - FILL OUT COMPLETELY! Internship Position Title: Hours per week: Internship Supervisor name: Supervisor title: Internship Department: Address: City: State: Zip: Supervisor phone with extension: Supervisor e mail: Start date: End Date: Compensation: Primary Internship responsibilities (Major responsibilities, duties, expectations, etc. of the internship, including size and scope. Please be specific.): Secondary Internship responsibilities (Please note that administrative, coaching, etc. tasks can only comprise up to 30% of the internship duties): Internship Project(s): (Is a specific project with an expected outcome?): Internship Qualifications / Skills: (Degree(s) required or preferred / in progress, experience required, and/or expected or special skills): PLEASE READ BEFORE S IGNING You certify that your proposed internship meets the following criteria: It is in a different department than my permanent role I will be reporting to a different supervisor I will have substantially different responsibilities than my permanent employment role and the internship responsibilities are closely connected to my field of study at Davenport University
Current%20Employment%20Verification%20Form%20EL%202017.docx