DC2-8076 Internship Application

First Name *

Last Name *

Address 1 *

Address 2

City *

State *

Zip Code *

Phone *

Email Address *

Are you a U.S. citizen, or legally authorized to work in the U.S.? *

If no, please attach required documents.

Have you ever been convicted of a first-degree misdemeanor or felony? *

If yes, please provide details. *

Have you ever pled nolo contendere or pled guilty to a crime which is a first-degree misdemeanor or felony? *

If yes, please provide details. *

Have you ever had the adjudication of guilt withheld for a crime which is a first-degree misdemeanor or felony? *

If yes, please provide details. *

Are you currently enrolled in a college or university? *

Yes

No

If yes, what is the name of the college or university?

What is your program or area of study?

Identify which semester(s) you are applying for. *

Education level:

GPA:

Anticipated Graduation Date +

How did you hear about out internship program?

Why do you want to intern at the Department of Corrections?

Program Area

Location

Do you have any prior experience in the program area you are applying to intern for?

Yes

No

If yes, please provide a brief description.

Proposed Schedule

Friday

Saturday

Sunday

Monday

Tuesday

Wednesday

Thursday

Total Hours:

Additional Skills

List any additional skills that you think will be beneficial to your internship.

Attachments

Please attach the following: DC2-899 Supplemental Application, copy of valid State ID or DL, cover letter, resume, and two (2) letters of recommendation. *

If no, do not complete application. Please contact the Internship Coordinator at (850) 717-9733.