Internship Application

Internship Application
Important Instructions

The background investigator in determining your suitability for the Internship
Program will use the information that you provide in this application. As you
complete this form, please keep the following in mind:
- All statements are subject to verification and any negative information will be evaluated fairly. Applicants will be disqualified for intentionally altering/misrepresenting the facts or omitting an incident that would not have otherwise disqualified them.
- Provide complete and accurate information. If you omit, or try to conceal any pertinent information you will be disqualified. If you are unsure if something is pertinent, include it in the appropriate section of this document.
- List all arrests and convictions even if you received a release, a pardon or had your record expunged. Again, if you are unsure if something is pertinent, include it in the appropriate section of this document.
- Be sure to provide complete and legible information about items requested. Your application will be evaluated for completeness and legibility. In instances where information requested is incomplete or illegible, applicants may be disqualified.
- This document will be strictly confidential. By signing this document, you acknowledge that you will not receive and are not entitled to know the contents of the confidential reports received. You further understand that these reports are privileged.
The Sheriff’s Office reviews this application to determine how well you follow instructions, assemble information, pay attention to detail, and submit a report or work product that is legible, accurate, and complete. The submission of this application is a test of your ability to provide the requested information for the Internship Program. It is also an opportunity for you to demonstrate that you possess these fundamental skills, which are critical to being successful in the Internship Program.

I certify that I have read the above information and understand that I am required to provide accurate and complete information. Furthermore, I understand that providing false or misleading information could result in my disqualification from consideration for the Internship Program.
Applicant Signature:

Clear
Date

MonthDayYear

Internship Application
Applicant
Name:

First NameMiddle NameLast Name
Social Security Number:
Date of Birth:

MonthDayYear
Sex:
Driver's License Number:
State of Issue:
Date Issued:

MonthDayYear
Class:
Expiration Date:

MonthDayYear
Email:
example@example.com
Phone Number:
Please enter a valid phone number.Format: (000) 000-0000.
Phone Number Type:
Any history of a change of name or use of another name?
If yes, list names, dates used and circumstances:
In case of emergency, who do we notify?
Name:

First NameLast Name
Relationship:
Address:

Street Address

Street Address Line 2

CityState

Zip Code
Phone Number:
Please enter a valid phone number.Format: (000) 000-0000.
Alternate Phone Number:
Please enter a valid phone number.Format: (000) 000-0000.

Internship Application
Internship
Internship Type:
What semester are you applying for?
Are you available on weekends, nights and/or holidays?
If no, explain:
Are there any areas of specialized interest you’d like your internship to emphasize?
If yes, explain:
Internship Coordinator:
Professor/Instructor:

First NameLast Name
Phone Number:
Please enter a valid phone number.Format: (000) 000-0000.
Email:
example@example.com

Internship Application
College/University
College or university you are CURRENTLY attending:
Permanent Residential Address:

Street Address

Street Address Line 2

CityState

Zip Code
School Residential Address:

Street Address

Street Address Line 2

CityState

Zip Code
Major:
Minor (if applicable):
Start Date:

MonthDayYear
Expected Graduation Date:

MonthDayYear
Hours Completed:
GPA:
Colleges You Previously Attended:
Have you attended other colleges?
College Name:
Major:
Minor (if applicable):
Start Date:

MonthDayYear
Graduation Date/End Date:

MonthDayYear
Hours Completed:
GPA:
Add additional college:
College Name:
Major:
Minor (if applicable):
Date Attended Start:

MonthDayYear
Date Attended End:

MonthDayYear
Hours Completed:
GPA:
Degree Earned:
List all college activities, academic awards, etc:

Internship Application
High School

High School/s you've attended:
School Name:
School Location:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Address:

Street Address

Street Address Line 2

CityState

Zip Code
Date Attended Start:

MonthDayYear
Date Attended End:

MonthDayYear
Diploma Earned:
Add additional high school?
School Name:
Location:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Date Attended Start:

MonthDayYear
Date Attended End:

MonthDayYear
Diploma Earned:
List all high school activities, academic awards, etc:

Internship Application
References
List three (3) persons who we may contact who are not related to you and who have definite knowledge of your qualifications and fitness for an intern position.
Reference Name 1:

First NameLast Name
Reference Address 1:

Street Address

Street Address Line 2

CityState

Zip Code
Reference Phone Number 1:
Please enter a valid phone number.Format: (000) 000-0000.
Relationship to Applicant:
Reference Name 2:

First NameLast Name
Reference Address 2:

Street Address

Street Address Line 2

CityState

Zip Code
Reference Phone Number 2:
Please enter a valid phone number.Format: (000) 000-0000.
Relationship to Applicant:
Reference Name 3:

First NameLast Name
Reference Address 3:

Street Address

Street Address Line 2

CityState

Zip Code
Reference Phone Number 3:
Please enter a valid phone number.Format: (000) 000-0000.
Relationship to Applicant:

Internship Application
Employment History

To complete this section, begin with your present or most recent employer first, and continue in reverse chronological order.
Have You Ever Been Employed?
1st Employer Name:
Employer Address:

Street Address

Street Address Line 2

CityState

Zip Code
Supervisor Name:
Phone Number:
Please enter a valid phone number.Format: (000) 000-0000.
Start Date:

MonthDayYear
End Date:

MonthDayYear
Position:
Duties:
Add more employers?
2nd Employer Name:
Employer Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Supervisor Name:
Phone Number:
Please enter a valid phone number.Format: (000) 000-0000.
Start Date:

MonthDayYear
End Date:

MonthDayYear
Position:
Duties:
Add more employers?
3rd Employer Name:
Employer Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Supervisor Name:
Phone Number:
Please enter a valid phone number.Format: (000) 000-0000.
Start Date:

MonthDayYear
End Date:

MonthDayYear
Position:
Duties:

Internship Application
Driving Record

List any traffic convictions for the last five years.
Have You Had Any Driving Incidents?
Incident #1
Date:

MonthDayYear
Charge:
Penalty:
City, State:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Add More Driving Incidents?
Incident #2
Date:

MonthDayYear
Charge:
Penalty:
City, State:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Add More Driving Incidents?
Incident #3
Date:

MonthDayYear
Charge:
Penalty:
City, State:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Add More Driving Incidents?
Incident #4
Date:

MonthDayYear
Charge:
Penalty:
City, State:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Internship Application
Crash Record

List any traffic crashes for the last five years.
Have You Had Any Crashes?
Traffic Crash #1
Date:

MonthDayYear
Nature of Accident:
Number of Injuries or Fatalities:
City, State:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Add More Traffic Crashes?
Traffic Crash #2
Date:

MonthDayYear
Nature of Accident:
Number of Injuries or Fatalities:
City, State:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Add More Traffic Crashes?
Traffic Crash #3
Date:

MonthDayYear
Nature of Accident:
Number of Injuries or Fatalities:
City, State:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Internship Application
Criminal History
Have you used any illegal drugs within the last three (3) years?
Please describe:
Have you been arrested for violation of a State or Local law (other than traffic)?
If Yes, list dates, City and State of violation:
Have you been convicted of a misdemeanor for violation of a State or Local law?
If Yes, list dates, City and State of conviction:
Have you been convicted of a felony for violation of a State or Federal law?
If Yes, list dates, City and State of conviction:
Writing Sample
In 150-300 words, describe why you want to enter the field of law enforcement and how this internship will benefit you.

0/300

Internship Application
Program Rules and Regulations

Interns are required to obey all federal, state, and local laws. Additionally, strict adherence to the following rules must be followed. Violation of these rules may be cause for removal from the internship program.

Sheriff's Office policies and procedures: Interns must follow all Sheriffs Office policies and procedures as outlined at the beginning of the internship. These include but are not limited to: sexual and other harassment, KCJIS requirements and dissemination of criminal history information, computer use, and standards of conduct.

Compensation: High School Interns are not compensated or granted benefits. Hours spent during the internship will be recorded for attendance purposes and course credit. College Interns will receive $21.00/hour for the duration of their 8 week program with a 40-hour work week schedule.

Safety: Interns must be institutionally aware and conduct themselves in a safe manner at all times. Unsafe acts, unsafe conditions, and all injuries must be reported immediately to a supervisor and, as soon as possible, to the Personnel Division Sergeant (913-715-5520).

Ride-Alongs: Interns are eligible to ride along with deputies but must abide by the procedure outlined in the section of this document titled "Internship Special Considerations."

Confidentiality: Interns shall treat the office business of the agency as confidential and shall not disseminate information regarding agency business or operations unless expressly permitted by supervisory staff.

Outside assignments: Interns may only prepare documents about their observation or experiences for the internship program and their college or high school requirements, with a copy of each provided to the Personnel Division Internship Coordinator(s) (Master Deputy Hutcheson - college or Deputy Paez- high school).

Weapons: Interns are prohibited from carrying weapons or handcuffs of any type.

Enforcement action: Interns are prohibited from taking any type of enforcement action. Interns shall not at any time represent themselves as sworn officers.

I.D. Badges: Interns must have their building access/identification card clearly displayed when entering the building and during scheduled work hours (except when impractical or detrimental to the progress of criminal investigations). Lost or stolen I.D. badges must be immediately reported to a supervisor and the Personnel Division Sergeant. Interns are required to return I.D. badges at the completion of the program.

Conduct: Interns shall not at any time engage in unbecoming conduct, which tends to discredit the Sheriffs Office or the school they are affiliated with. This includes posts or submissions to social media. Photographs of agency operations are prohibited unless specifically authorized by a supervisor. Use of electronic devices or cell phones is prohibited unless approved by a supervisor.

Driving of Agency Vehicles: Interns shall not drive agency vehicles. Interns shall wear seat belts when riding in an agency vehicle.

Courtesy: Interns shall not use profane or intentionally insulting or degrading language or act in such a manner towards any member of the agency or to any citizen. Interns shall be courteous and tactful in the performance of their duties and shall promptly respond to all reasonable requests for assistance. Interns shall refer to sworn staff members by their appropriate rank and last name.

Punctuality and Attendance: Interns are required to punctually report for their assigned duties. Time off during the internship shall be coordinated with the Personnel Division Internship Coordinator(s) at least three days in advance. In the event an illness or emergency prevents attendance, contact the supervisor in your assigned unit and the Personnel Division Internship Coordinator(s) prior to the designated shift.

Appearance: Interns representing the Sheriffs Office shall maintain a neat, well-groomed appearance, with attire and footwear that is appropriate for an office work environment (agency issued uniform). Supervisors may allow adjustments to this rule for certain work situations when appropriate. Agency policies concerning civilian employees will be the standard for Interns.

Absolutely NO: sandals, flip-flops, shorts, cut-offs, t-shirts, tank tops or
clothing with offensive wording, logos, or images.

Schedules: All Interns shall receive a schedule indicating their assigned units and hours.

Grade/Monitoring: The Intern will be assessed on attendance at duty assignments and proficiency of any tasks assigned. If your teacher/professor has a specific requirement, please advise your JCSO Intern Coordinator.

Violations of any rules: Interns who violate these rules or any agency policy will be subject to sanctions, including and up to the removal from the Internship Program.

I have read all rules, policies, and procedures provided to me and agree to follow all rules, policies and procedures. I have been given the opportunity to ask questions about any rule, policy, or procedure. I also understand failure to follow any rule, policy, or procedure could result in any sanction, up to and including removal from the internship program with an unsatisfactory grade reported to my professor and/or other school staff.
Signature of Intern:

Clear
Printed Name of Intern:
Date:

MonthDayYear

Internship Application
Intership Special Considerations

Ride-along:

Interns are allowed to ride along with a deputy to gain a better understanding of daily law enforcement operations as it correlates to some of our divisions and special units. Interns must be aware there is a risk associated with riding with deputy. Ride-alongs are NOT mandatory, but if a ride-along is conducted, the procedure below will be followed:
- The Patrol Commander or their designee will provide the intern a safety orientation prior to participating in any ride-along. The orientation will include the location of patrol car equipment such as the police radio. Interns will also review policy and procedure and be made aware of the potential dangers of a ride-along.
- Interns may accompany deputies into non-public areas unless the property owner or representative asks them to leave OR there is a reasonable belief their presence could be detrimental to the investigation.
- Interns will NOT be allowed to accompany a deputy into a situation where it is reasonable to believe their safety could be jeopardized. Prior to arrival at such incidents, the intern should be left at a location, such as a gas station, and Communications will be informed to send a different unit to resume the ride along.
- Interns will be assigned by a supervisor to ride with a deputy who is NOT on probation. The deputy may maintain regular district duties, engage in emergency driving (but will not engage in pursuits), and transport non-violent prisoners with the intern.
- Interns may accompany deputies into booking areas with non-violent prisoners.
- Supervisors may discontinue any intern ride along at their discretion for any reason including call load or staffing issues.
- Interns are allowed to attend meetings and briefings; however, supervisors will not discuss personnel matters with interns.
- Interns have access to view KCJIS information but will not be involved with major criminal investigations. Interns must meet and maintain the requirements for KCJIS information.
As a condition precedent to being permitted to participate in the Ride-Along program and ride as a gratuitous passenger in a vehicle or vehicles operated by any deputy or person employed by the Sheriffs Office of Johnson County, Kansas, I, the undersigned, knowingly and voluntarily assume any and all risks inherent to participating in this program.

I understand as a rider and participant that I might be exposed to dangers in excess of those normally faced by passengers in private vehicles. I further certify that I have received a briefing relative to these dangers prior to placing my signature on this document. I further waive any right or claim against the Sheriffs Office of Johnson County or the Board of County Commissioners of Johnson County, their officials, officers and employees for loss of life, bodily injury or property damage that I may sustain as a result of riding as a gratuitous passenger and participating in this program.
Intern Signature:

Clear
Intern Printed Name:
Date:

MonthDayYear

Internship Application
Criminal Background Records Waiver of Liability, Disclosure, Authorization and Release

Individuals applying for an Internship with the Johnson County Sheriff’s Office are required to have a background check completed on them and must be cleared before being allowed access into the Sheriff’s Office. Such individuals will be required to maintain satisfactory criminal history records.

The following documents must be provided before the clearance can be made:
- Copy of driver’s license
- Applicants must be fingerprinted prior to receiving clearance.
I hereby request and authorize any officer of the Johnson County Sheriff’s Office, or authorized representative to be provided and view any and all information discovered concerning:
- Criminal Background Records/Information, including municipal, county, state and federal records
- Offender Registry Information
- US Citizenship or authorization to work in the US, social security and address verification
I voluntarily waive all rights of recourse and release the Johnson County, Kansas, Sheriff’s Office from any and all liability for compliance with this authorization. Furthermore, I understand this release is signed, free from duress and with the full knowledge and understanding that, any information obtained will be used in assessing my authorization to have access to any Johnson County, Kansas, Sheriff’s Office facilities.

I believe to the best of my knowledge that all information I have provided is accurate, true, correct and that I fully understand the terms of this release.

Criminal History Record Information Confidentiality Awareness and Compliance Statement

In the course of being a FacilitiesNendor/Contract Worker working with the Johnson County Sheriff you may have access to various electronic data storage and retrieval systems, including NCIC, REJIS, KCJIS, JIMS and Intergraph ("Data Systems"). These systems contain and provide users ("Operators") with criminal history record information.

This criminal history record information is classified and confidential

Dissemination of this information is strictly controlled by the Criminal History Record Information User Agreements executed between the Sheriff and the State of Kansas, and between the Sheriff and the REJIS. Use and dissemination is also restricted by federal law (28 U.S.C. § 534}; federal regulations (Title 28 CFR §20.1 et seq.); state law (K.S.A. § 22-4701 et seq.); and state regulations (K.A.R. 10-9-1 et seq.)
Intern Signature:

Clear
Date:

MonthDayYear
Intern Printed Name:
Emergency Contact:

First NameLast Name
Phone Number:
Please enter a valid phone number.Format: (000) 000-0000.
Should be Empty:

Internship Application

Important Instructions

Internship Application

Applicant

In case of emergency, who do we notify?

Internship Application

Internship

Internship Coordinator:

Internship Application

College/University

Colleges You Previously Attended:

Internship Application

High School

Internship Application

References

Internship Application

Employment History

Internship Application

Driving Record

Incident #1

Incident #2

Incident #3

Incident #4

Internship Application

Crash Record

Traffic Crash #1

Traffic Crash #2

Traffic Crash #3

Internship Application

Criminal History

Writing Sample

Internship Application

Program Rules and Regulations

Internship Application

Intership Special Considerations

Internship Application

Criminal Background Records Waiver of Liability, Disclosure, Authorization and Release