APPLICATION FOR STUDENT SUMMER HIRE PROGRAM- 2011

RETURN COMPLETED FORM TO : CLONewDelhi@state.gov

By February 1, 2011

STUDENT'S NAME:

(Last) (First) (Middle Initial)

DOB: PLACE OF BIRTH:

(m/d/yyyy) (City) (State) (Country)

 number where you can be reached during office hours:
Street address in New Delhi:  number:
Street address in the U.S.:  number:
Sponsor’s name: Relationship:
Sponsor’s agency/office: Sponsor’s office email:
Sponsor’s  number: Sponsor’s home email:
Sponsor’s projected departure date from post: (m/d/yyyy)

Dates available for work

(must be at least 4 consecutive weeks):

Planned vacation(s):
(check with your family please):

Education: Highest level completed:

Some HS HS/GED Associate Bachelor Master Doctorate

th th th th
High School : 9 grade 10 grade 11 grade 12 grade
Level just finished: st nd rd th th
College: 1 Year 2 Year 3 year 4 Year 5 year

Clerical work Experience: None 3 months 6 months 1 year more than 1 Year
Computer skills:
(check the applications you are familiar with) Word Excel Access Outlook PowerPoint

Typing Skills: Yes No If yes, approximate typing speed: words per minute

English: reading speaking

Language Skills
(please rate your ability)
E=Excellent V=Very Good G= Good F=Fair P= Poor N= Not Applicable
Prior work experience:
(New Delhi and elsewhere; include volunteer
work, include dates)
Have you ever been employed by the U. S.
Yes No
government?
Were you ever in Military Service? Yes No

If yes, were you discharged? Yes No N/A If yes, when?

Have you ever had a security clearance? Yes No

If yes, what level? Sensitive But Unclassified Secret Top Secret Don’t know

When was it granted or revalidated? / (m/yyyy)

Summer hire positions are available throughout the Mission:

Agency State Department

I would prefer to work at:

I would like to work in the section (s):

I prefer not to work in the section(s):

The above information is correct and is provided by the following person:

(print name) Date:

(mm/dd/yyyy)

Please note that additional information and forms will be required in order to process
your security clearance. These forms will be sent to you by HR and should be completed
as soon as possible but no later than February 15, 2011.