Section 1 of 6 in this document

Student Internship Application

Semester/Term (select one)

Fall Semester

Spring Semester

Summer Term

Name

Phone Number

Do you have a car to use if necessary? (This is not a requirement)

Yes

Are you fluent in any other language(s)?

Yes

What language(s) are you fluent in?

Section 2 of 6 in this document

Emergency Contact Information

Emergency Contact Name

Relationship

Cell or Home Phone

Work Phone

Education

Current College/University

Main Phone Number

Major(s)

GPA

Month and Year Graduating

Academic Advisor

Advisor's Phone

List any special workshops, training sessions, courses or volunteer or criminal justice experiences that relate to the internship position for which you are applying?

Have you attended any other colleges or universities?

Yes

Name of college/university, dates attended and major

Section 3 of 6 in this document

Employment

Have you ever been, or are you now employed?

Yes

Employer Name

Employer Address

Job Title

Dates of Employment (Start Date - End Date)

Do you want to add another job to your employment history?

Yes

Employer Name

Employer Address

Job Title

Dates of Employment (Start Date - End Date)

Section 4 of 6 in this document

Background

Have you ever been adjudicated delinquent or convicted of a crime?

Yes

Date of Arrest

Where were you arrested? (town/city)

Nature of adjudication /conviction and disposition

Are any of your family members and/or friends currently on probation; parole; or incarcerated in Chester County?

Yes

List the name(s) and the supervising agency:

Section 5 of 6 in this document

Internship Information

Academic Level

Graduate

Undergraduate

Dates of Requested Internship (start date and end date)

Will you be receiving academic credit for this internship?

Yes

Hours required by college/university

Days and Hours of availability

School Internship Coordinator

Phone Number

Attach Resume and Cover Letter

I certify that the answers to all of the questions on this application are complete and true to the best of my knowledge and belief.

I agree

I understand that any false answers, statements or representations made by me in this application shall constitute sufficient cause for dismissal and/or penalties under 18 PA CONS, STAT., Section 5904 related to the unsworn falsification to authorities.

I agree

I understand that nothing contained in this application or granting of an interview is intended to create an employment contract between the County of Chester and myself. I acknowledge that if for any reason I am not selected for an Internship, the Chester County Juvenile Probation Department is under no obligation to explain why. I also acknowledge if chosen for an internship, that I may be terminated or released from service at any time, without cause, and without right to appeal.

I agree

The County of Chester considers all applicants without regard to race, color, religion, ethnicity, gender, national origin, age, physical handicap, or any other protected status or classification in accordance with state and federal laws. The County of Chester also provides “reasonable accommodations” to qualified individuals with known disabilities, in accordance with the Americans with Disabilities Act.

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Student Internship Application

Semester/Term (select one)

Home Address

Do you have a car to use if necessary? (This is not a requirement)

Are you fluent in any other language(s)?

Emergency Contact Information

Education

Have you attended any other colleges or universities?

Employment

Have you ever been, or are you now employed?

Do you want to add another job to your employment history?

Background

Have you ever been adjudicated delinquent or convicted of a crime?

Date of Arrest

Are any of your family members and/or friends currently on probation; parole; or incarcerated in Chester County?

Internship Information

Academic Level

Will you be receiving academic credit for this internship?

Attach Resume and Cover Letter

I certify that the answers to all of the questions on this application are complete and true to the best of my knowledge and belief.

I understand that any false answers, statements or representations made by me in this application shall constitute sufficient cause for dismissal and/or penalties under 18 PA CONS, STAT., Section 5904 related to the unsworn falsification to authorities.

Sign Here