![INTERNSHIP/VOLUNTEER PROFILE AND INDENTITY FORM Volunteer](https://wadadia-nonprofits.org/wp-content/uploads/2020/12/39746431_10212710554584192_811412303961391104_o_edited.jpg)
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HEAD OFFICE: Gangu Plaza, Behind Barclays Bank, Mumias Town on Mumias – Lumino Road. INTERNSHIP/VOLUNTEER PROFILE AND INDENTITY FORM
Intern/Volunteer Personal Information
Name _______________________________________________________
Country of Origin ______________________________________________
State / County of Origin __________________________________________________
Home Address__________________________________________________________
Current Address_________________________________________________________
E-Mail Address _______________________________________________________
Business/ Work Tel N0. + Code ____________________________________________
Cell Number________________________________________________
Best time to call: __________________________ Date of Birth: ____________
Gender: ____________ Nationality ____________
Blood Group ____________
Marital Status ____________
Sponsor _________________
Proposed Duration of Stay (in months) __________ From ____________ To_______________
Preferred Accommodation: Own arrangement Host family/Community
Highest Educational Qualification (please specify achievement)
Secondary School Graduate Post Graduate Doctorate Others Current Occupation / Identity
Student
Housewife Employed Unemployed Retired Volunteer
Others
PLEASE MARK BOX WITH RED COLOUR
Internship/Volunteer Service Information:
“Per Week” for How Many hours are you available for Internship/volunteer assignments?
25 Hrs 40 Hrs 30 Hrs 45 Hrs 35 Hrs 50 Hrs Please indicate any previous work experience as a Volunteer or Intern in other Organization/s: (with contact reference/s if available)
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How did you know about us: ________________________________________________________________
Briefly describe why you want to be an Intern/volunteer at WADADIA:
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Tell us in which areas you are interested in Internship/volunteering:-
Administrative / Finance Economic Empowerment Reproductive Health Psychosocial Support Fundraising Other (please state)
PLEASE MARK BOX WITH RED COLOUR
Do you have a specific achievement goal that you plan to accomplish through Internship/Volunteer experience?
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Briefly describe your hobbies & Interests:
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Person to Notify in Case of Emergency
Name __________________________________ Contact No __________________________
Statement of Understanding & Agreement to the Conditions of the Internship
I understand that, should I be accepted as an intern at WADADIA, the following conditions will apply:
- Status. Although I will be an Intern and will not be considered a member of the regular WADADIA staff, I shall still be subject to all of WADADIA’s rules and policies.
- Financial Support. I will not be paid a salary by WADADIA. I am personally responsible for all of my visa, travel and living costs during my internship with WADADIA, including my travel costs from and to my home/ home country (if applicable), and the cost of my accommodation, meals and other living expenses during the internship.
- Medical/Health/Travel Insurance. WADADIA accepts no responsibility for costs arising from illnesses or accidents which occur during the internship. I will therefore have in place adequate medical/health/travel insurance to cover such events, should they happen. The following health/travel insurance company will cover me during the internship period.
Insurer (name, contact information): ________________________________________
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For international interns (please note that internship with WADADIA cannot be approved unless you provide this information).
- Visa. WADADIA will issue a letter confirming my acceptance as an Intern and the conditions governing my internship so that I can obtain a visa for my internship. However, I am personally responsible for obtaining the visa that is required for my country of internship.
- Confidentiality. As an intern, I will respect the confidentiality of information that I collect and/or am exposed to at WADADIA. No reports, papers, internal documents or information of any kind obtained from WADADIA may be published or shared externally without the explicit written authorization of WADADIA.
- Intellectual Property Rights: In case of research interns, WADADIA shall be entitled to all property rights, including but not limited to patents copyrights and trademarks with regard to material, which bears a direct relation to or is made in consequence of the services provided to the Foundation by the intern. At the request of the Foundation the intern shall assist in securing such property rights and transferring them to the Foundation in compliance with the requirements of the applicable law.
- Adherence to WADADIA’s Rules, Regulations and Policies: If my application is approved, I promise to adhere to WADADIA’s Rules, Regulations and Policies. I understand that my internship may be terminated if I fail to adhere to these, as this may constitute a breach of contract.
I agree to all points in this section. By submitting this application, I affirm that the facts set forth in it are true and complete. I understand that if I am accepted as a Intern/volunteer, any false statements, omissions, or other misrepresentations made by me on this application may result in my immediate dismissal.
Our Organization appreciates your interest in working with us, we are looking forward to your service for the betterment of our Community and its posterity. However, the organization will not be held responsible for anything that happens to you while offering your Internship/Volunteer services to it:
Name of Intern/Volunteer _____________________________ Signature: ________________
FOR OFFICIAL USE ONLY
Application Approved _____ Application Rejected _________
Remarks___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Signature of the registration officer __________________________ Date: ___________________
It is the policy of WADADIA to provide equal opportunities without regard to race, color, religion, national origin, gender, sexual preference, age, or disability. Please note that WADADIA reserves the right to approve or reject applications for internship with or without an explanation
Thank you for completing this application form and for your interest in Internship/Volunteering with us.