CBAPract Form 001

COLLEGE OF BUSINESS AND ACCOUNTANCY

INTERNSHIP APPLICATION FORM

PERSONAL DATA

NAME: ________________________________________________________S.N.: __________

(Last Name) (First Name) (Middle Name)
MAILING ADDRESS: _________________________________________________________
#/street town/city zip code
AGE: ______ BIRTHPLACE: ___________________ SEX: _______ BIRTH DATE: _________

NATIONALITY: ___________________ HEIGHT: _____________ WEIGHT: _______________

EMAIL ADDRESS: ______________________________ PHONE NUMBER: _______________

COURSE: Accounting Technology

Business Management

FATHER'S NAME: ________________________ AGE: ______ OCCUPATION: ____________

MOTHER'S NAME: ________________________ AGE: ______ OCCUPATION: ____________

ACHIEVEMENTS (Include Awards, Scholarships, Special Recognition, or other College

Community Participation):

Activities Date Awards Received

____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
___________________________________________________________________________

TRAININGS/SEMINARS ATTENDED, if any:

Title Venue Date

____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________

WORK EXPERIENCE/EMPLOYMENT RECORD:

Have you work for any establishment/company?

Yes No
If yes, please indicate below:

Name of Firm/Company Position Date of Employment (From - To)

_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________

CHARACTER REFERENCES:

Name Profession Company and Telephone Number

____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________

Answer the following:

What is the importance of a Practicum Program in my career?

____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________

How can I improve my personality through the practicum program?

____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________

What are my office and computer skills?

____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________

Recommended/Target Practicum Site:

Name of Company Contact Person/Position

____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________

This is to certify that all information in this form are true and correct.

SIGNATURE OVER PRINTED NAME:

DATE: