USDA Career Intern Program Application

U.S. Department of Agriculture

Agency or Mission Area
USDA Career Intern Program Application

1. TYPE/FIELD OF WORK YOU ARE APPLYING FOR:

PART A. APPLICANT'S INFORMATION

2. NAME (Last, First, Middle)

3. ARE YOU A U.S. CITIZEN? (Check applicable box below. Only U.S. Citizens are elgible for his program.)

4. BIRTHPLACE (City and State, Country and State, or Foreign Country)

5. TEMPORARY MAILING ADDRESS (Including Zip Code)

6. PERMANENT MAILING ADDRESS (Including Zip Code)

7. TEMPORARY TELEPHONE NUMBER (Including Area Code)

8. PERMANENT TELEPHONE NUMBER (including Area Code)

9. E-MAIL ADDRESS

10. VETERAN'S PREFERENCE (Check applicable box that applies to you.)

NONE	5-POINT	10-POINT DISABILITY	10-POINT COMPENSABLE
10-POINT OTHER	10-POINT COMPENSABLE/30 PERCENT

(Attach Form DD-214, Report of Transfer or Military Discharge, and Form SF-15, Application for 10-Point Veteran's Preference, or Department of Defense or Department of Veterans Affairs documentation as appropriate.)

PART B. EDUCATIONAL BACKGROUND

11. NAME AND ADDRESS OF COLLEGE OR UNIVERSITY ATTENDED

12. COLLEGE OR UNIVERSITY TELEPHONE NUMBER (Area Code)

13. MAJOR/GRADUATE PROGRAM

14. DATE OF GRADUATION (MM-DD-YYYY) Date must be withn six months of application date if you have not completed college.

15. GRADE POINT AVERAGE

16. LIST OF FOREIGN LANGUAGES

17. COMMUNITY SERVICE EXPERIENCE

18. AWARDS (Include dates, types of award, monetary value, etc.)

19. LEADERSHIP EXAMPLES:

PART C. GEOGRAPIC LOCATIONS (Please check the following geographic lcations (states) where you wish to work.)
Alabama	Alaska	Arizona	Arkansas
California	Colorado	Connecticut	Delaware
District of Columbia	Florida	Georgia	Hawaii
Idaho	Illinois	Indiana	Iowa
Kansas	Kentucky	Louisiana	Maine
Maryland	Massachusets	Michigan	Minnesota
Mississippi	Missouri	Montana	Nebraska
Nevada	New Hampshire	New Jersey	New Mexico
New York	North Carolina	North Dakota	Ohio
Oklahoma	Oregon	Pennsylvania	Rhode Island
South Carolina	South Dakota	Tennessee	Texas
Utah	Vermont	Virginia	Washington
West Virginia	Wisconsin	Wyoming
PART D. APPLICANT'S CERTIFICATION AND SIGNATURE
I certify that, to the best of my knowledge and belief, all of the information I have provided in this application is made in good faith. I consent to the release of information from schools, employers, and other individuals and organizations about my abilty and fitness for Federal employment.
20. APPLICANT'S SIGNATURE		21. DATE (MM-DD-YYYY)

APPLICANTS: PLEASE ATTACH YOUR RESUME TO THIS APPLICATION

The U.S. Department of Agriculture (USDA) prohibits discrimination in all its programs and activities on the basis of race, color, national origin, gender, age, disability, and where applicable, sex, marital status, familial status, parental status, religion, sexual orientation, genetic information, political beliefs, reprisal, or because all or part of an individual?s income is derived from any public assistance program. (Not all prohibited bases apply to all programs.) Persons with disabilities who require alternative means for communication of program information (Braille, large print, audiotape, etc.) should contact USDA?s TARGET Center at (202) 720-2600 (voice and TDD).

To file a complaint of discrimination, write to USDA, Director, Office of Civil Rights, 1400 Independence Avenue, S.W., Washington, D.C. 20250-9410 or call (800) 795-3272 (voice) or (202) 720-6382 (TDD). USDA is an equal opportunity provider and employer.