INTERNSHIP APPLICATION
Please submit this application along with your resume and cover letter. OMSI will not consider incomplete applications.
Please note that OMSI internships are unpaid, volunteer opportunities.
Internship Position(s) You are Seeking
Date of Application
How did you learn about this position?
Advertisement (specify) __________________________
Friend
OMSI Employee
Visiting OMSI Website (specify) ___________________College (Specify) _________________
Personal Information
First Name
Last Name
Address
City
State
Home Phone #
Zip
 Preferred Number?
Email
 Preferred Number?
Cell Phone #
Permanent Address (if different than above)
City
State
Zip Code
Permanent Phone #
Emergency Contact Name
Relationship
Phone #
Yes No
Have you ever been employed or volunteered with OMSI before?
If yes, give date and position:
To the extent permitted by applicable law, have you ever been convicted of a crime? (Note: the existence of a
conviction record is not necessarily a bar to serving as an intern.)
Yes No
If yes, please give details and dates: ___________________________________________
Can you provide volunteer service with reasonable or no accommodation?
Yes N
Availability and Interests
Date available to begin: ______________________
I will commit to at least (circle: 3
6
9
I can commit to up to ______ hours per week.
12 ) months as an OMSI intern.
Please circle when you are available: M T W Th F Sat Sun
Mornings
Afternoons
Evenings
If you are applying for an internship in Science Education, please rank the top five (5) OMSI Science
Education areas that interest you, where 1 is your area of highest preference for placement, and 5 is your area
of lowest preference for placement (but is still an area in which you’d be interested):
___
___
___
___
Chemistry Lab
Physics Lab
Design Lab
Life Science Lab
___
___
___
___
Food Science
___ Teen Science Alliance
Featured Exhibits Hall
Earth Science Hall (Paleo and Earth Science Labs)
Early Childhood Education (Science Playground)
Education and Training
Name of School
Course of Study (include
focus, if applicable)
#
Yrs
Degree
Yes
Undergraduate
School
No
Yes
Graduate
School
No
Please list any applicable coursework/training (include software) ________________________________
______________________________________________________________________________________________
Work Experience
Are You Currently Employed?
Yes
No
If yes, please list your current place of employment: ______________________________________
Job title: _____________________________________________
Professional/Personal References
Name
1.
Email Address and Phone Number
Title
2.
Applicant’s Certification – please read carefully before signing this application
OMSI is an equal opportunity employer and is dedicated to similarly extending that same commitment to its volunteer
positions; therefore we will consider applicants for all volunteer internship positions without regard to race, color, sex,
religion, creed, age, national origin, sexual orientation, gender identity, citizenship status, physical or mental disability,
veteran's status, or any other status protected under applicable local, state, or federal law.
The skill-sets of intern applicants are generally compared to those skill-sets needed to fulfill current internship positions.
Placement is typically made based on the recommendation of the volunteer staff and the applicant's prospective
volunteer supervisor, and the willingness and ability of the applicant to perform the required volunteer duties at the
times needed by the museum. Interns must be able to perform activities of daily living without assistance from OMSI
staff while volunteering.

I certify that I have answered truthfully and have not knowingly withheld any information relative to my
application. I understand that any misrepresentation or material omission of the application will result in my
being eliminated from further consideration. I further understand that, if accepted, any misrepresentation on
written applications or in interviews that becomes known to OMSI may result in immediate dismissal.

I authorize all previous employers, supervisors, and others with information, including all persons with and for
whom I have worked or volunteered, to give OMSI’s representative any relevant information regarding my
previous employment or volunteerism, and job or volunteer performance. I release OMSI and all previous
employers, supervisors, or others with information from liability for any damages that may result from furnishing
information to OMSI.

I acknowledge and agree that I offer my services as a volunteer intern at my own initiative and for humanitarian
purposes, without promise, expectation or receipt of pay or future employment.

I understand that I will be required to attend an orientation and department specific training.

I agree to abide by existing and future instruction, rules and policies of OMSI. I understand that my volunteer
position may be terminated at any time, at the option of either OMSI or myself.
I have read, understand and agree to the above certification statements and other information on the
application.
Applicant’s Signature
Date
Typed name accepted as signature