First District of Leyte, Room 614, North Wing

House of Representatives, Batasan Hills, Quezon City

INTERNSHIP APPLICATION FORM

Please print or type legibly. Do not leave any space blank.

PERSONAL INFORMATION
FIRST NAME
MIDDLE NAME
LAST NAME
PARTICULARS

2 x 2 photograph
in business
or professional attire

Age
Date of Birth
Place of Birth
Sex
Nationality
Religion
Permanent Home Address
Complete Mailing Address
Telephone Number
Mobile Number
Email Address
Father's Name
Mother's Name

ACADEMIC BACKGROUND
ELEMENTARY

SECONDARY

TERTIARY

Name of School
Address
Inclusive Years
Honors Received
Leadership Position
Name of School
Address
Inclusive Years
Honors Received
Leadership Position
Name of School
Degree Program
Address
Inclusive Years
Honors Received
Leadership Position
Use separate sheet of paper, if necessary.

LEADERSHIP RECORD AND COMMUNITY INVOLVEMENT

NAME OF ORGANIZATION
Title or Position
Years in Office
Accomplishments

NAME OF ORGANIZATION
Title or Position
Years in Office
Accomplishments

NAME OF ORGANIZATION
Title or Position
Years in Office
Accomplishments

Use separate sheet of paper, if necessary.

RECOMMENDATION OF SCHOOL HEAD

This is to recommend Mr. / Ms.

, of legal age, a student/graduate

Complete Name of Student

of this college/ university, taking up (or graduated with) the degree

College Degree

Furthermore, this is to attest that the aforementioned is of good moral standing in our college/university.

Signature over Printed Name of School Head

Designation / Position

COLLEGE OR
UNIVERSITY

Name of School
Complete Mailing Address
Phone
Fax
Email
I attest upon my honor that all statements made in this form are true and correct.

Applicant's Signature over Printed Name

Date Accomplished

2 x 2 photograph
in business
or professional attire

al age, a student/graduate

College Degree

Date Accomplished