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2. Personal Information
4. Name*
5. Date of Birth*
   Date of Birth
7. Address*
9. City*
10. State*
11. Zip Code*
13. Primary Phone*
14. Secondary Phone
16. Email Address*
20. School Information
22. Name of University or College*
23. Major*
25. Is this internship a requirement for graduation*

    1. Yes
    2. No
26. Are you in good standing with your college or university?*

    1. Yes
    2. No
28. Does your internship require 200+ hours?*

    1. Yes
    2. No
29. What semester do you plan on completing your internship?*
    -- Select One --FallSpringSummer
31. Letter of Recommendation*

    You must include a letter of recommendation from your school’s internship coordinator. The letter must identify you as a student in good standing, currently enrolled in curriculum focused on Criminal Justice or Law Enforcement Administration, and must state that the internship is required for completion of the course of study.

32. Internship Details*

    Please submit a document which details your school’s internship requirements.

34. Driver's License*

    Please submit a copy of your driver's license. 

38. References

    List the names of three adults, not related to you, and not former employers, who have known you for a period of preferably more than five years.  Persons listed may be asked to appraise your character, ability, experience, personality and other qualities: 

40. Name *
42. Address*
44. Phone*
46. Name*
48. Address*
50. Phone*
52. Name*
54. Address*
56. Phone*
60. Why do you want to intern with Peoria County*

    Please explain in your own words why you want to do your internship with the Peoria County Sheriff's Office. 

64. The undersigned, for and in consideration of being allowed to participate in the pre-employment examination process for criminal justice agency employment by the Peoria County Sheriff's Office, hereby releases and discharges the County of Peoria, a body politic and corporate, its officers, employees, and agents, of and from any and all claims, demands, causes of action and liabilities to me, my heirs and my assigns, which may result for any and all losses and damages arising wholly or partially as a result of the examinations, and/or any pre-employment background investigations conducted by and for the Peoria County Sheriff's Office.

66. The undersigned authorizes the release of medical, military, educational, credit, criminal history, and personal information from all sources to the County of Peoria for use in any pre-employment background examination.

68. In making such authorization, I release both the contributor and the County of Peoria, State of Illinois, from all liability for any damage whatsoever arising there from and I release both agents of the contributor and agents of the County of Peoria from all liability for any damage whatsoever arising there from.

70. Electronic Signature Agreement*

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
72. Electronic Signature
73. Date*
    Date
Leave This Blank:


75. 1. Receive an email copy of this form.
76. Email address

    This field is not part of the form submission.

77. Submit

* indicates a required field