APPLICATION FOR INTERNSHIP Notice: Applications must be typewritten or clearly printed. All questions must be answered. If a question is not applicable enter “NA”. Applications that are incomplete or illegible will not be considered. Use additional sheets if the space allotted is insufficient for a complete answer. 701 North 7th Street Kansas City, Kansas 66109 Police Academy (913) 596-2056 PERSONAL HISTORY

Name:

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PRESENT ADDRESS

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Street, City, Zip:	_________________________________________________________________________________________________________________________________________________________________________________
Phone:	( _____ )______________________

PERMANENT ADDRESS(If Different)

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Street, City, Zip:	_________________________________________________________________________________________________________________________________________________________________________________
Phone:	( _____ )______________________

INTERNSHIP AREAS OF INTEREST

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1. ______________________________________________________________________

2. ______________________________________________________________________

3. ______________________________________________________________________

COLLEGE / UNIVERSITY / HIGH SCHOOL PRESENTLY ATTENDING

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Name:	_________________________________________________
Street, City, Zip:	_________________________________________________________________________________________________________________________________________________________________________________
Phone:	( _____ )______________________

CURRENT FACULTY ADVISOR

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Name:	_________________________________________________
Street, City, Zip:	_________________________________________________________________________________________________________________________________________________________________________________
Phone:	( _____ )______________________

ACTIVITIES / ORGANIZATIONS / OFFICES HELD

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HONORS / AWARDS

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CITIZENSHIP

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Are you a U.S. citizen? ( ) Yes ( ) No If naturalized, Date of Entry _______________ Place of Entry _____________________________ Court ___________________________________________________________________________ Date ___________________ Place __________________________________________________

AUTO DRIVERS LICENSE

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Issuing State __________ License Number ___________________________________________

COURT RECORD

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List all CONVICTIONS for criminal or traffic offenses (except parking). DATE PLACE CHARGE DISPOSITION DETAILS                         Felony convictions will disqualify you. All other criminal involvement will be carefully evaluated.

PRESENT / PREVIOUS JOBS(Include title and length of time)

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CURRENT FACULTY ADVISOR

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Name:	_________________________________________________
Street, City, Zip:	_________________________________________________________________________________________________________________________________________________________________________________
Phone:	( _____ ) ______________________

EMERGENCY CONTACT PERSON

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Name:	_________________________________________________
Street, City, Zip:	_________________________________________________________________________________________________________________________________________________________________________________
Relationship:	___________________________________________________________
Phone:	( _____ )______________________

The Kansas City, Kansas Police Department’s Internship Program will not discriminate on the basis of age, sex, disability, race, color, religion, martial status, or ethnic origin. All Internships are for credit only.