Internship Application

Internship Application

1. Student Information
Name: Phone: Email: College/University:
Are you currently employed by the IDOC? Yes No (If yes, IDOC Manager approval is required.)
Have you ever been employed by the IDOC? Yes No
If you answered ‘yes’ to the above question, the work location was:
If you answered ‘yes’ to the above question, the position of employment was:
Major(s): Class Standing:
Undergraduate (Bachelor) Graduate (Masters) Post-Graduate (Licensing or PhD)
2. College/University Information
College/University Contact Name: Phone: Email address:
3. Internship Information
Internship Position Title: Date Available:
Desired W ork Location: No. Hours Available Per Week:

A. W hat do you hope to learn or gain from an internship with the IDOC? (E.g., what are the learning objectives?) Please be specific.

B. How will you accomplish the learning objectives? List the steps and please be specific.

C. How will you measure the results?

D. How do you see this internship affecting your short and long-term career goals?

E. Submit this form to your school’s internship department head or instructor for approval.
To qualify for an internship with IDOC, your internship must be endorsed by your school as a part of an official course of study.

School Dept Head/Professor’s Name Signature Date

4. IDOC Division Manager Approval
Internship Application

This section is for applicants who are currently employed with the IDOC.
If you are not a current IDOC employee, proceed to section 5.
Current Division Mana g e r:
Approved: Yes No If no, please explain below.

Current Division Manager Name Signature Date
Internship Division Mana g e r
Approved: Yes No If no, please explain below.

Internship Division Manager Name Signature Date
5. Site Internship Coordinator Approval
Internship Position Title:
Internship Start Date: Internship End Date: Work Location Assigned:
Intern Supervisor Assigned: Student’s Assigned W ork Schedule:

A. The student will be evaluated on the following workplace skills and other specific duties assigned:


Attendance

Job Knowledge

Quality of W ork
 Versatility


Appearance

Learning Objectives

Quantity of W ork
 Working Relationships


Initiative

Observance of IDOC Policies

Self-confidence


B. The student will require access to the following IDOC information technology infrastructure:
EDOC Reflections CIS
Note: The site coordinator should submit a helpdesk request to IDOC IT for computer access.
C. Attachments: Please attach the following forms to this packet and submit to the IDOC Internship Coordinator in Human Resources:
Background Investigation Questionnaire Relationship Disclosure Form

Approved: Yes No

Student’s Signature Date

Site Internship Coordinator’s Name Signature Date
6. IDOC Internship Coordinator Approval

ET&R Approval required: Yes No

ET&R Coordinator’s Name Signature Date

IDOC Internship Coordinator’s Name Signature Date