Phenetics Inc.

Internship Application Form

https://docs.google.com/forms/d/1cU_Gu6YtN98dGsq...

Phenetics Inc. Internship Application Form

As a condition of internship, I give permission for Phenetics organization to conduct
background check(s) on me now and as long as I continue to be active with the organization,
which may include a review of sex offender registries, child abuse and criminal history
records. I understand that, if appointed, my position is conditional upon the company
receiving no inappropriate information on my background. I hereby release and agree to
hold harmless from liability Phenetics, and its affiliates, the officers, employees and
internships thereof, or any other person or organization that may provide such information. I
also understand that, regardless of previous appointments, Phenetics is not obligated to
appoint me to an internship or employment position. If appointed, I understand that, prior to
the expiration of my term, Phenetics is no longer subjected to any work arrangement or
employment requirement to intern. Violations to Phenetics Inc. company policy or
agreements could result in suspension by the President, CEO, or representative with
Phenetics Inc. and removal by the Board of Directors for violation of Phenetics policies or
principles. You must be 18 years or older to engage in any internship with Phenetics.
Phenetics Inc. Company Handbook is agreed and accepted to the terms by completing this
online form. You can request a copy or view the documents online at:
https://www.scribd.com/doc/252301308/Phenetics-EmployeeHandbook?secret_password=GbouDBPIZYnQHeqrPD7p
NOTE: Phenetics and its affiliates will not discriminate against any person on the basis of
race, creed, color, national origin, marital status, gender, sexual orientation or disability.
For more information please visit www.phenetics.com
Thank You, Phenetics Team
* Required

1. Candidate Name *
Enter your full legal name as shown on a
valid government issued identification.

2. Date
The month day and year you are completing this application
Example: December 15, 2012
3. Date of Birth? *
When were you born?
Example: December 15, 2012

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4. University *
The University this day you are actively
attending.

5. Degree Type *
The University this day you are actively attending.
Check all that apply.
Bachelors
Masters
PhD
MBA
Other:
6. Graduation Date *
The University Graduation Date day you are planning on ?
Example: December 15, 2012
7. Are you a US citizen? *
Were you born or have US citizenship?
Mark only one oval.
Yes, I am a US Citizen
No, I am not a US Citizen
Other:
8. What is your current visa status? *
Visa information, please check official documents.
Mark only one oval.
F-1 Student
CPT
OPT
H1-B
N/A
Other:
9. Address *
The city you currently in, what is the street
address?

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10. City *
What city are you currently in?

11. State *
What city are you currently in?

12. Zip Code *

What zip code is connected to your
address?

13. Cellular Phone

What is your cellular phone number?

14. Other Phone

Do you have a home, work, or other phone
number to share?

15. Email Address? *

What is the best way to send you electronic
mail? Gmail is preferred

16. Are you willing to relocate for a position? *

Company can place you in a different geographical region that where you are now
Mark only one oval.
Yes
No
Other:
17. Occupation?
Are you currently working? It's fine if you
are. We'll just need more effort to balance
time.

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18. What company are you currently

employed? *
Who do you work for If you have a job?

19. Occupation Address

Where is the company you work for If
applicable?

20. How many hours are you available to

work? *
How many hours are you available to work?

21. Special professional training, skills, hobbies?

List any Special professional training, skills, hobbies.

22. Community affiliations (Clubs, Service Organizations, etc.)?

List any clubs, service organizations, etc.. that you are part of. This can be school related
or not.

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23. Previous internship experience (include date)?

If you were part of any internships in the past what was it like?

24. Do you have relatives in the program?

Yes? No? If yes, list full name and what level? Friends are not necessary to list.

25. Special Certification (CPR, Medical, etc.)?

Yes? No? These can be short to the point answers. List any if you can.

26. Do you have a valid drivers license (Other Identification)?

Yes? No? If you do Great! But if not it's alright also.

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27. Drivers License or Other ID #?

Any other Identification you care to list?

28. What State?

What State was the Drivers License or other ID in? Remember, If you don't have it that's
fine.

29. Have you ever been convicted of or plead guilty to any crime(s)? *
Yes or No, If yes, describe each in full please

30. Are there any criminal charges pending against you regarding any crime(s)
involving or against a minor? *
Yes or No, If yes, describe each in full please

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31. Have you ever been refused participation in any other internship programs?
Yes or No, If yes, describe each in full please

32. In which of the following would you like to participate? *

You can check one or more.
Check all that apply.
IT/ Information Systems
Research & Development
Business Development
Customer Support/ Assistance.
Sales
Marketing
Organizational Systems
Management & OPS.

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33. Phenetics Inc. Proprietary Rights & Confidentiality Agreement THIS PROPRIETARY
RIGHTS AND CONFIDENTIALITY AGREEMENT (this "Agreement") is made as of
DATE OF EXECUTION IN CURRENT FORM between Phenetics Inc. on behalf of
itself and its affiliates (collectively, the "Company") and the undersigned individual
performing work and is affiliated with the Company ("Team Member"). In
consideration of Team Member's engagement as a team member of the Company
and for other good and valuable consideration, the receipt and sufficiency of which
is hereby acknowledged, the parties hereto intending to be legally bound agree as
follows: 1. Protection of Confidential Information. (a) Obligation to Maintain
Confidentiality. Team Member acknowledges and agrees that the continued
success of the Company depends upon the use and protection of a large body of
confidential and proprietary information. All of such confidential and proprietary
information now existing or to be developed in the future will be referred to in this
Agreement as "Confidential Information." Confidential Information will be
interpreted as broadly as possible to include all information of any sort (whether
merely remembered or embodied in a tangible or intangible form) that is (i) related
to the Company's current or potential business and (ii) is not generally or publicly
known. Confidential Information includes, without limitation, the information,
observations and data obtained by Team Member during the course of his service
as a Team Member of the Company concerning the business and affairs of the
Company and includes third party confidential information. Therefore, Team
Member agrees that he shall not, at any time during or after his service as a Team
Member of the Company, disclose to any unauthorized person or use for his own
account any of such Confidential Information without the prior written consent of
the Company, unless and to the extent that any Confidential Information
(i) becomes generally known to and available for use by the public other than as a
result of Team Member's acts or omissions or (ii) is required to be disclosed
pursuant to any applicable law or court order, provided that with respect to
clause (ii), Team Member shall at the earliest practicable date provide a copy of the
subpoena or court order to the Company's general counsel. Team Member agrees
to deliver to the Company at the end of his service as a Team Member of the
Company, or at any other time upon request, all tools, supplies and Confidential
Information, along with all copies.
(b) Use of Information of
Employers. During Team Member's service as a Team Member of the Company,
Team Member is not requested to, and shall not, use or disclose any confidential
information of any employer of the Team Member or any other person to whom
Team Member has an obligation of confidentiality.
(c) Additional
Acknowledgments. Team Member acknowledges and agrees that he has carefully
read this Agreement and has given careful consideration to the restraints imposed
upon Team Member by this Agreement, and is in full accord as to their necessity
for the reasonable and proper protection of Confidential Information of the
Company. Team Member expressly acknowledges and agrees that each and every
restraint imposed by this Agreement is reasonable with respect to subject matter,
time period and geographical area. 2. Miscellaneous. (a) No Guarantee. This
Agreement shall not be construed and is not intended by either Team Member or
the Company to be a guarantee, commitment or understanding of Team Member's
continued service as a Team Member of the Company for any period of time.
(b) Remedies. Because Team Member's services are unique and because Team
Member has access to Confidential Information and Developments, the parties
hereto agree that money damages would not be an adequate remedy for any
breach of this Agreement. Therefore, in the event of a breach or threatened breach
of this Agreement, the Company, in addition to other rights and remedies existing
in its favor, shall be entitled to specific performance and/or injunctive or other
equitable relief from a court of competent jurisdiction in order to enforce, or
prevent any violations of, the provisions hereof (without posting a bond or other

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security). (c) Survival. Team Member's obligations under this Agreement shall
survive termination of Team Member's service as a Team Member of the Company
and shall thereafter be enforceable whether or not such termination is later claimed
or found to be wrongful or to constitute or result in a breach of any contract or of
any other duty owed or claimed to be owned by the Company to Team Member.
(d) Entire Agreement. This Agreement supersedes all prior agreements between
the Company and Team Member related to the subject matter hereto, and cannot be
modified except in writing signed by the parties hereto. (e) Assignment. This
Agreement shall be binding upon Team Member and his heirs, successors and
legal representatives and shall be binding upon and inure to the benefit of the
Company and its successors and assigns. The Company may freely assign this
Agreement. Team Member not assign this Agreement or his rights and obligations
hereunder. (f) Governing Law. This Agreement shall be governed by the laws of
the State of California (without reference to conflict of laws provisions).
(g) Representations. Team Member represents that there is no agreement with
any other party that would conflict with his obligations under this Agreement Team
Member represents and warrants that he (i) has read and understands each and
every provision of this Agreement, (ii) has had the opportunity to obtain advice
from legal counsel of his choice in order to interpret any and all provisions of this
Agreement and (iii) has had the opportunity to ask the Company questions about
this Agreement and any of such questions he has asked have been answered to
his satisfaction. *
Phenetics Inc. Proprietary Rights & Confidentiality Agreement
Mark only one oval.
Confirm
34. e-Signature Needed & Current Date from
Applicant *
Please submit your full name as shown on a
valid ID. Please also include the current date
(Month/ Day/ Year)

35. e-Signature Needed & Current Date from

Official Company Representative
Please submit your full name as shown on a
valid I.D. Please also include the current
date (Month/ Day/ Year)

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