D. Victor Reynolds INTERN APPLICATION FORM. Home Address: other PH. Person to contact in case of emergency phone Relationship

Transcription

1 O FFI C E OF THE DISTRICT ATTORNEY D. Victor Reynolds DISTRICT ATTORNEY, COBB JUDICIAL CIRCUIT 70 Haynes Street, Marietta, Georgia Telephone (770) Facsimile (770) INTERN APPLICATION FORM Name Home Address: Date Phone other PH Person to contact in case of emergency phone Relationship ADDRESS: Education: (circle the last year High School: completed for each) College: degree/study Grad School: degree/study Are you currently employed: Y / N If yes, where how long Job Title major duties Please describe why you would like to work with the Investigations Unit:..

2 In order to get to know you better, please list any of the following: Special skills: Special training: Interests/hobbies: Please list any clubs to which you belong or any other organizational affiliations: Have you ever been convicted of a crime: Y / N (excluding minor traffic violations, but not excluding nolo pleas) If yes, please state the nature, the date and location of the offense. You may further provide a brief narrative of this incident on another sheet of paper and attach to this form.. Have you ever been the victim of a crime: Y / N If yes, please describe the victimization including the year and county in which the offense occurred. An additional sheet of paper can be attached to the application if needed..

3 Please list any previous volunteer experience: place / duties 1) 2) As an intern, you will be working with individuals of many different ethnic, religious, and socioeconomic backgrounds. They may have values and beliefs different from your own. Please describe why this will or will not present a difficulty or adjustment for you:. Please list any areas of concern that will affect your ability to work here (mental/physical disabilities):. Please list any additional strengths or skills that you would like to develop during your work with the Investigations Unit: _. Please provide the following information: School: Department: Expected Graduation: Faculty / school intern advisor s name and contact information: Name phone

4 References: One reference must be a college professor. One reference must be a current/former employer. One reference must be of your personal character. NAME PHONE 1) College Professor: 2) Employer: 3) Character: All information submitted via this application and any/or resume is true to the best of my knowledge. I understand that any false or misleading information provided in this application is grounds for being denied the opportunity to volunteer or intern at the District Attorney s Office Investigation Unit. Printed name Signature Date Thank you for your interest in volunteering or interning with the District Attorney s Office Investigations Unit and for your cooperation in completing this application. Date of applicant interview: Staring Date of applicant: Termination Date of applicant if applicable: Reason:

5 CONSENT TO OBTAIN CRIMINAL HISTORY I hereby authorize the Office of the District Attorney, Cobb Judicial Circuit, State of Georgia, to receive any criminal history record information pertaining to me which may be in the files of any Federal, State, or Local criminal justice agency. NAME DATE OF BIRTH STREET ADDRESS CITY/STATE/ZIP DRIVER S LICENSE NUMBER SOCIAL SECURITY NUMBER MAIDEN NAME OR ALIAS NAME RACE GENDER (if applicable) SIGNED DATE

6 Academic Transcript Request In addition to your application we will need a certified copy of your academic transcript. This should be MAILED to the following address. Inv. Rebekah Weiler District Attorney s Office 70 Haynes Street Marietta, Georgia NOTE: This does NOT have to be sent with your application packet. The packet can be faxed or scanned/ ed to me for quicker processing. Additional writings: 1) Please attach with your application a one page summary on why you wish to intern with the DA s office and what your future goals are following a possible internship. 2) Please have 3 letters of recommendation MAILED to our offices, to the attention of Inv. Weiler. If your recommendations are coming for employees of Cobb County Government they can me directly from their county issued . Inv. R. R. Weiler CCDA 3 rd fl 70 Haynes St Marietta, GA NOTE: These 3 letters must come from 3 different individuals than listed in the application packet (not the same employer, educator, or character reference already used as a reference).