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NPD Internship Application

Steps

1. Applicant Information This section is complete This section is incomplete
2. References This section is complete This section is incomplete
3. Professional Skills This section is complete This section is incomplete
4. REFERENCE RELEASE OF LIABILITY This section is complete This section is incomplete
5. APPLICATION CERTIFICATION This section is complete This section is incomplete

Applicant Information

Applicant Information
Last Name*
First Name*
Middle Initial
Date of Birth*
Date of Birth
Sex*
Do you have a driver's license?*
Email*
Phone*
Cell Phone *
Any history of a change of name or use of another name?*
If yes, list names, dates used and circumstances
Permanent Residential Address*
City, State, Zip Code*
School Residential Address*
City, State, Zip Code*
In case of emergency, whom shall we notify?
Emergency Contact Name*
Address*
City, State, Zip Code*
Internship Information
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
College/University Information
College or university you are currently attending*
Major/Minor*
Dates Attended*
Hours Completed*
GPA*
Internship Coordinator Name*
Phone Number *
Email *
Address*
City, State, Zip *
Have you previously another college and university?*
College/University Name*
Major/Minor*
Dates Attended*
Hours Completed*
GPA*
Degree Earned*
List college activities, academic awards, etc.*
High School Information
School Name*
City and State*
Dates Attended*
Diploma Earned?*
List high school activities, academic awards, etc.*
Did you attend more than one high school?*
School Name*
City and State*
Dates Attended*
Diploma Earned?*
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References

List three 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 1 Name*
Phone Number*
Address*
City, State, and Zip*
Relationship*
Reference 2 Name*
Phone Number *
Address*
City, State, and Zip*
Relationship *
Reference 3 Name*
Phone Number*
Address*
City, State, and Zip*
Relationship*
Employment History
To complete this section, begin with your present or more recent employer first, and continue in reverse chronological order.
Firm Name*
Address*
City, State, and Zip*
Phone Number *
Supervisor's Name*
Start Date and End Date*
Start Date and End Date Start Date
—
Start Date and End Date End Date
Position*
Duties*
Firm Name*
Address*
City, State, Zip *
Phone Number*
Supervisor's Name*
Start Date and End Date*
Start Date and End Date Start Date
—
Start Date and End Date End Date
Position*
Duties*
Firm Name*
Address*
City, State, Zip*
Phone Number*
Supervisor's Name*
Start Date and End Date*
Start Date and End Date Start Date
—
Start Date and End Date End Date
Position*
Duties*
Military Experience
Have you ever or are you now serving in the military?*
Branch of Service*
Service Dates*
Highest Rank Earned *
Specialization Duties *
Have you been the subject of a military court martial?*
If Yes, list dates, circumstances and outcome*
Driving Record
List any traffic convictions for the last five years.
Have you received any traffic convictions in the past 5 years?*
Date
Charge
Penalty
City and State
Date
Charge
Penalty
City and State
Date
Charge
Penalty
City and State
Date
Charge
Penalty
City and State
Crash Record
List any traffic crashes for the last five years.
Have you been involved in any traffic crashes in the past 5 years?*
Date
Nature of Accident
Number of injuries/fatalities
City and State
Date
Nature of Accident
Number of injuries/fatalities
City and State
Date
Nature of Accident
Number of injuries/fatalities
City and State
Criminal History
Have you been arrested for violation of a State or Local law (other than traffic)?*
List dates, city, and state of violation*
Have you been convicted of a misdemeanor for violation of a State or Local law?*
List dates, city, and state of conviction*
Have you been convicted of a felony for violation of a State or Federal law?*
List dates, city, and state of conviction*
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Professional Skills

Whenever possible, Normal Police Department attempts to fully utilize the skills of our interns. Please indicate your level of expertise in each of the skill areas listed below.
Accounting/Bookkeeping*
Statistics*
MS Word*
MS Excel*
MS Access*
MS PowerPoint*
MS Outlook*
Keyboarding/Typing*
Photography/Videography*
Research*
Additional skills*
Writing Sample*
In 150-300 words, describe why you want to enter the field of law enforcement
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REFERENCE RELEASE OF LIABILITY

Please read
I respectfully request that you forward to the Town of Normal, Illinois, any and all information that you have concerning me, my work record, or my reputation. This includes any information that may appear in my personnel file, criminal conviction records, or other confidential files or records. This information will be used to determine my qualifications and fitness for the position of Intern I am seeking with the Town of Normal. I hereby release you and/or your employer from any liability and/or damage of whatever nature due to the furnishing of such information requested above. Further, I acknowledge that the internship program typically involves riding in agency vehicles and participating in policing activities. I realize that such activity involves risk of personal injury or property damage, and I hereby assume such risk and release and agree to hold harmless the Town of Normal, the Normal Police Department, their officers, agents and employees from any liability for civil damages arising out of their actions or the actions of others in connection with this activity. In consideration of participating in the ride-a-long program, I further covenant and agree, as a condition of the granting of my internship request, to indemnify and hold harmless the Town or Normal, the Normal Police Department, their officers, agents and employees from any liability which may be incurred by them or either of them proximately resulting from any acts or omissions by me during this activity. I further represent that I am above the age of 18 years, with full understanding of all risks involved and agree that this release and its indemnity agreement shall be binding upon my heirs, executors, administrators, and assigns. A copy of this release is as valid as the original signed REFERENCE RELEASE OF LIABILITY even though the copy does not have my original signature.
I respectfully request that you forward to the Town of Normal, Illinois, any and all information that you have concerning me, my work record, or my reputation. This includes any information that may appear in my personnel file, criminal conviction records, or other confidential files or records. This information will be used to determine my qualifications and fitness for the position of Intern I am seeking with the Town of Normal. I hereby release you and/or your employer from any liability and/or damage of whatever nature due to the furnishing of such information requested above. Further, I acknowledge that the internship program typically involves riding in agency vehicles and participating in policing activities. I realize that such activity involves risk of personal injury or property damage, and I hereby assume such risk and release and agree to hold harmless the Town of Normal, the Normal Police Department, their officers, agents and employees from any liability for civil damages arising out of their actions or the actions of others in connection with this activity. In consideration of participating in the ride-a-long program, I further covenant and agree, as a condition of the granting of my internship request, to indemnify and hold harmless the Town or Normal, the Normal Police Department, their officers, agents and employees from any liability which may be incurred by them or either of them proximately resulting from any acts or omissions by me during this activity. I further represent that I am above the age of 18 years, with full understanding of all risks involved and agree that this release and its indemnity agreement shall be binding upon my heirs, executors, administrators, and assigns. A copy of this release is as valid as the original signed REFERENCE RELEASE OF LIABILITY even though the copy does not have my original signature.
Electronic Signature*
By my electronic signature, I certify that I have read and understand the Reference Release of Liability.
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APPLICATION CERTIFICATION

Please read
I hereby certify that all answers to the above questions are true and I agree and understand that any false statement contained in this application may cause rejection of this application or termination of internship, and shall constitute gross misconduct for benefit eligibility. I understand that an incomplete application may result in a lost internship opportunity. I authorize the Town of Normal to contact my current and past employers and personnel references listed above to verify employment, work records, and suitability for internship with the Town, and to investigate personal, criminal, or other areas, such as personal contact with neighbors, friends, or others with whom I am acquainted. This inquiry includes information as to my character, general reputation, personal characteristics, and mode of living. I understand that my appointment to an internship may be subject to satisfactorily completing a pre-employment medical exam, including drug and alcohol screen, and that the truthfulness of the statements in this application may be verified by polygraph examination. I understand that I will have to provide acceptable documentation attesting that I am a U.S. citizen. I understand that this application is not a contract of internship. I understand that any oral or written statement to the contrary is expressly disavowed, and should not be relied upon by my prospective or existing employee.
I hereby certify that all answers to the above questions are true and I agree and understand that any false statement contained in this application may cause rejection of this application or termination of internship, and shall constitute gross misconduct for benefit eligibility. I understand that an incomplete application may result in a lost internship opportunity. I authorize the Town of Normal to contact my current and past employers and personnel references listed above to verify employment, work records, and suitability for internship with the Town, and to investigate personal, criminal, or other areas, such as personal contact with neighbors, friends, or others with whom I am acquainted. This inquiry includes information as to my character, general reputation, personal characteristics, and mode of living. I understand that my appointment to an internship may be subject to satisfactorily completing a pre-employment medical exam, including drug and alcohol screen, and that the truthfulness of the statements in this application may be verified by polygraph examination. I understand that I will have to provide acceptable documentation attesting that I am a U.S. citizen. I understand that this application is not a contract of internship. I understand that any oral or written statement to the contrary is expressly disavowed, and should not be relied upon by my prospective or existing employee.
Electronic Signature*
By my electronic Signature, I certify that I have read and understand the statements above.
INTERNSHIP RULES
Please read the Internship Rules as stated on http://www.normal.org/699/Internship.
Electronic Signature*
By my electronic signature, I certify that I have read and understand the Internship Rules.

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NPD Internship Application

Steps

Applicant Information

Applicant Information

In case of emergency, whom shall we notify?

Internship Information

College/University Information

High School Information

References

List three 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.

Employment History

Military Experience

Driving Record

Crash Record

Criminal History

Professional Skills

Whenever possible, Normal Police Department attempts to fully utilize the skills of our interns. Please indicate your level of expertise in each of the skill areas listed below.

REFERENCE RELEASE OF LIABILITY

Please read

APPLICATION CERTIFICATION

Please read

INTERNSHIP RULES

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