Memphis Zoo Internship Application

Date Received __________
For Office Use Only Revised 02/2010
Memphis Zoo Internship Application
Please return completed application to:
Brandy Weigandt, Volunteer Coordinator, Memphis Zoo
2000 Prentiss Place, Memphis, TN 38112.
For additional information, please call (901) 333-6500.
PERSONAL INFORMATION
Date of application: ________________
Name: ____________________________________________________________________________________
(Last) (First) (M.I.)
Permanent Address: ___________________________________________________________________ ______________
(Street number) (Apt. #)
City: _____________________________________ State: __________ Zip Code: _________________________
Primary Phone #: ____________________________ Secondary Phone #: __________________________________
Personal Email: __________________________________________________
Birth Date: __________________________ SSN #: _____________________________________
APPLICATIONS MUST BE COMPLETE, WITH A VALID GPA, BIRTHDATE, AND SOCIAL SECURITY
NUMBER IN ORDER TO BE CONSIDERED.
Please attach a resume if you have one.
Type of internship for which you are applying (please circle): Spring / Summer / Fall / Winter / Flexible
Please list the area(s) in which you would like to intern: __________________________________________
Dates available: _____________________ Days and hours available: ______________________________
Education Level School Name and Location Last Year Completed Major and Degree GPA
High School
College or University 1 2 3 4 5 6
Classes or coursework relevant to position: _______________________________________________________
__________________________________________________________________________________________
Computer skills and training: ___________________________________________________________________
__________________________________________________________________________________________
Other relevant training or experience: ______________________________________________________
__________________________________________________________________________________

VOLUNTEER INFORMATION
Have you ever done any volunteer work and / or internship before? Circle one: Yes
No
If so, please provide the organization’s name, volunteer coordinator’s name, dates of service, and a
description of volunteer work performed.__________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
Why do you want to intern at the Memphis Zoo and Aquarium? ________________________________
__________________________________________________________________________________
__________________________________________________________________________________
Are you currently a member of the Memphis Zoological Society? Yes / No
Membership #:__________
How did you hear about our internships? _________________________________________________
PERSONAL / PROFESSIONAL REFERENCES
1.
Name: Address: Occupation: Telephone: Relationship:
2.
3.
EMERGENCY INFORMATION
Do you have any medical conditions that we should be aware of in case of a medical emergency?
__________________________________________________________________________________
__________________________________________________________________________________
Emergency Contact Name and relationship to
you:
Home Phone:
Work Phone:
Emergency Contact Name and relationship to
you:
Home Phone:
Work Phone:

BACKGROUND INFORMATION
Have you ever been convicted of a crime? Yes No If yes, list all convictions, showing offense and
date: _____________________________________________________________________________
__________________________________________________________________________________
Have you ever been known by any other name(s) which MZS will require to verify any of the information
contained in this application? Yes No If yes, list here: ___________________________________
Have you lived in any other state in the past 10 years? Yes No If so, which? _________________
__________________________________________________________________________________
Authorization for Release of Information
I understand that the information on my volunteer application is subject to check and
verification by Memphis Zoological Society doing business as Memphis Zoo, and that my
previous and present employers, organizations, and volunteer associations may be asked for
information as to my character and record with them.
I hereby grant permission to the Memphis Zoological Society, doing business as the Memphis
Zoo to contact these employers, organizations, and volunteer associations, and further, I hereby
authorize my former and/or present employers, organizations, and volunteer associations to
give any information as to my character and employment record with them.
I also grant permission to Memphis Zoological Society doing business as the Memphis Zoo to
obtain information from and/or copy police and court records in order to conduct a prevolunteer
investigation on me.
I hereby release from all liability and damages those individuals, companies, organizations, or
agencies who provide information as stated above.
Should I become a volunteer, I agree to comply with all rules and regulations of Memphis
Zoological Society doing business as Memphis Zoo.
Signature:
Date: