DC3-2019 Internship Application 9/2/09 - Join the Florida ...



FLORIDA DEPARTMENT OF CORRECTIONS

Internship Application

I. REQUIRED BACKGROUND INFORMATION:

|Name: |      | |      | |      | |      |

| |Last | |First | |Middle | |Maiden |

|Personal Address: |      |

| |Street Address |

|      | |      | |      | |      |

|City | |State | |Zip | |Telephone #1 |

|      | |      | |      |

|Telephone #2 | |Fax # | |E-Mail |

| |

| |

|University/College Information: |

|University: |      |Advisor’s Name: |      |

|Address: |      |Phone: |      |

|City: |      |State: |      |Zip: |      |

| |

| |

|A background check is required; please provide the following information for that purpose: |

|Driver's License #: |      | Date of Birth: |      |

| |

|Gender: |      | Race/Ethnic Origin: |      | Social Security Number: |      |

| |

|Have you ever been arrested on a misdemeanor or felony charge? Yes No If yes, explain: |

|      |

| |

|Have you ever been convicted on a misdemeanor or felony charge? Yes No If yes, explain: |

|      |

|(A criminal record will not automatically exclude you from an internship position.) |

| |

|Have you ever worked for the Florida Department of Corrections? Yes No If yes, specify the |

| |

|facility/office, location, and dates. |      |

| |

|Do you have any relatives working for the Department of Corrections? Yes No If yes, provide: |

|Name: |      |Relationship: |      |

|Work Location: |      |

| |

|Do you have any relatives or friends under the custody/care/control of the Department of |

|Corrections? Yes No If yes, provide: Name: |      |

|Relationship: |      |Facility: |      |

| |

|In case of emergency notify: |      | |      |

| Name (area code + number) |

| |

|I CONFIRM THAT ALL INFORMATION IS ACCURATE AND COMPLETE. |

| |

| | | | |

|Signature | |Date | |

In accordance with s. 119.071(5) (a) 2, F.S., your social security number is being collected for the purpose of conducting a criminal background check as prescribed by law and in accordance with departmental policies, procedures, and the American Correctional Association Standards. The Department will not use your social security number for any purpose other than the purpose provided above.

II. GUIDELINES FOR ETHICAL AND BEHAVIORAL CONDUCT

In consideration of the opportunity to serve in the Department of Corrections as an Intern, I agree to abide by the following Ethical and Behavioral guidelines:

Intern will work in cooperation with staff.

Intern will honor the civil and legal rights of all offenders/inmates.

No intern will use his/her official position to secure privileges or advantage for himself/herself.

No intern will use his/her official position to promote any partisan political purpose.

Each intern will report unethical behavior or rule violations.

Individuals will not discriminate against any offender/inmate, employee, or prospective employee on the basis of race, sex, creed, national origin or religious preference.

Keep scheduled hours as agreed.

Dress appropriately for the correctional environment.

Abide by the rules, regulations, policies, and procedures of the Florida Department of Corrections.

Acknowledge the drug-free workplace policy of the Department of Corrections and be subject to random drug testing.

Without appropriate approval will not buy, give, exchange, etc., gifts, messages, money, or contraband with any individual under the supervision of the Department of Corrections or with anyone else acting on behalf of anyone under supervision.

Avoid undue familiarity with any individual under the supervision of the Department of Corrections, except as noted in the Intern Procedure.

Not allow my behavior to be influenced by the attempts of offenders/inmates to manipulate others for their own benefit.

I agree to abide by the policies and procedures regarding confidentiality of records and information.

III. WAIVER OF LIABILITY

I hereby waive all liability to the Department of Corrections and its employees, for any and all injuries which may occur to me during my term of service with the Department of Corrections. Interns, when working for the department, are covered by Worker’s Compensation in accordance with Chapter 440 of the Florida Statutes. I understand that I am the person responsible to ensure that I am in compliance with any and all applicable State Law, Department of Corrections Policy, or any Regulation which may affect me during this period.

I have received orientation as an intern and have read the Guidelines for Ethical and Behavioral Conduct, Waiver of Liability, and agree to abide by the conditions therein.

Signature: ____________________________________________ Date: ________________________

|Degree or Classification: |      | |Major: |      |

| | | | | |

|List any special training, certificates, licenses, or accomplishments: |      |

|      |

| | |

|Most recent or current place of employment: |      |

| | |

|Supervisor’s Name: |      |Supervisor’s Telephone Number: |      |

| | |

|Why do you want to be an intern with the Florida Department of Corrections? |      |

|      |

| | |

|What are your primary areas of interest and special skills? |      |

|      |

| | |

|Where would you like to intern? |      |

| |Name of facility/office/department |

| | |

|Do you have language signing abilities? | Yes No |

| | |

|Do you have translation or speaking abilities in another language? | Yes No |

|If yes, what language(s)? |      |

| | |

|How long can you commit yourself as an intern? (minimum of one (1) academic semester/term) |

| 1-3 months 3-6 months 6-9 months 1 year Longer |      |

| |Specify |

|What are your hours of availability for your internship experience? (Indicate specific hours of time. Minimum of four (4) hour blocks of time excluding community|

|corrections positions, mandatory forty (40) hours per week.) |

|Monday: |      | Tuesday: |      |Wednesday: |      | |

|Thursday: |      | Friday: |      | | | |

| | |

|What date can you start your intern work experience? |      |

You may be using your personal vehicle for the accomplishment of some of your assigned intern duties, e.g. observing violation court hearings. If you have a personal vehicle, please attach a copy of the auto insurance card.

Signature:__________________________________________ Date:__________________________

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