GO Internship Application

Please upload your current resume and a cover letter:*

You may also upload additional documents/sample work, etc. that you would like for us to see.

List of References*

Conduct and Competency
It is the purpose of Street Hope/Garland Oaks to ensure a safe, sound and secure environment for the residents in order to aid their health and healing. As part of our licensure process with various entities (Department of Children’s Services, etc.), we are required to ensure soundness of staff and other related individuals (e.g., interns, etc.) who will interact professionally with the residents. Please answer completely the following questions related to conduct and competency.

Have you ever been expelled, terminated, reprimanded for or disciplined by an employer or educational institution for misconduct including (1) dishonesty/fraud/deceit, (2) lying or misrepresentation on a resume or academic application, (3) academic misconduct (including cheating or plagiarism), (4) theft/destruction of property, and/or (5) sexual harassment/misconduct?*

YesNo

If yes, please explain:

Have you ever been denied a social work, counseling, psychotherapy, counseling-related or other allied health-related license or renewal in any state?*

YesNo

If yes, please explain.

Have you ever been denied the right to take a social work, counseling, psychotherapy, counseling-related, or other allied health-related licensure examination?*

YesNo

If yes, please explain.

Have you ever had a license to practice any profession revoked, suspended, sanctioned or otherwise disciplined and/or had to participate in a disciplinary proceeding/administrative action in any state?*

YesNo

If yes, please explain.

Is there any current or pending or do you anticipate any complaint against your professional conduct or competency in any state or jurisdiction in any social work, counseling, psychotherapy, counseling-related, or other allied health-related profession?*

YesNo

If yes, please explain.

Do you currently have any condition or impairment (may include but not limited to substance abuse/misuse, alcohol abuse/misuse, mental condition, and/or medical condition) which currently affects your ability to practice and/or your ability to deliver essential services related to your course of study/major/concentration for this internship?*

YesNo

If yes, please explain.

Is there any other information you would like to share?*

YesNo

List any additional information.

Release Allowing Street Hope/Garland Oaks to Conduct Background Checks/Reviews:

I understand that I will need to complete a background check/fingerprint check to participate as an intern with Street Hope/Garland Oaks and that results of this background check/fingerprint check may affect my participation with Street Hope/Garland Oaks. I understand and release Street Hope/Garland Oaks to check my educational institutions, employers and volunteer entities. I understand and release Street Hope/Garland Oaks to check social media accounts and/or conduct a thorough search of my online presence and that results of this check may affect my participation with Street Hope/Garland Oaks. I release and hold harmless Street Hope/Garland Oaks from any liability related to the results of these background checks/reviews.

Signature*

Date*

Date

Garland Oaks Internship Application

Internship Information