Thank you for your interest to intern or volunteer with the Florida Department of Health in Lake County! Please complete this application form so that we can help you find an appropriate internship or volunteer opportunity. Once you complete the form, click the submit button at the bottom.



Contact Information


Demographic

You may opt to provide the following information. It is only used to help us get a better idea of the demographic make-up of the applicant.



Skills & Experience

In which of these areas do you feel you have moderate to excellent skill? Please detail those skills and experiences that you feel are relevant to your preferred internship or volunteer placements.




Availability

Please indicate the days and times you are usually available to participate in an internship or volunteer.



Assignment Preference

The following internship / volunteer assignments may currently be available. You may click the assignment names to learn more about that assignment. Use this list to rank your top three assignment choices.



Emergency Contact

In the event of an emergency whom should we notify?



Employer

Please list your current or most recent employer, if applicable.



Reference

Please enter the contact information for one character reference.



EMail

We like to keep interns and volunteers informed of important news, schedules, and volunteer opportunities by email, however will not send you any email you prefer not to receive. Use the checkboxes below to select the kinds of email you would like to receive from us.



Criminal Background and History

All Florida Department of Health in Lake County interns and volunteers are required to undergo a Level II Background screening prior to providing services. Please indicate any criminal background or history in the following field:



Intern / Volunteer Information Center

We provide an online "Internship / Volunteer Information Center" where interns / volunteers may check their schedules, update their information, and receive messages. Please select the password you would like to use to access the online Intern / Volunteer Information Center.



I Agree

It shall be a misdemeanor of the first degree to fail to disclose, by false statement misrepresentation, impersonations or other fraudulent means, any material fact used in making a determination as to a person’s qualifications to work as a volunteer.


I understand that, to protect persons served by the department, a routine check through law enforcement, license bureaus, agency files, and references may be made. I understand that a criminal offense will not automatically exclude me from all volunteer positions; however, certain convictions will exclude me from volunteering in some positions. I understand that if I answered no to the criminal offense question on the front of this application and a record should be obtained, it will prevent me from volunteering for the department regardless of the offense. I understand upon submission of this application it becomes public record.


I understand and agree that all information as it relates to persons served by the department is to be held confidential in compliance with Florida Statutes. All information that should come to my attention and knowledge as privileged and confidential will not be disclosed to anyone other than authorized personnel and that I shall conduct myself in accordance with the departmental security policies. I understand that failure to comply may result in criminal prosecution.


I affirm that all information on this application is true and correct.