Form ISP 1-189 Application for Illinois State Police Internship Application - Illinois

Form ISP1-189 or the "Application For Illinois State Police Internship Application" is a form issued by the Illinois State Police.

Download a PDF version of the Form ISP1-189 down below or find it on the Illinois State Police Forms website.

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ILLINOIS STATE POLICE
INTERNSHIP PROGRAM GUIDELINES
All students considered for the Illinois State Police (ISP) Internship Program must be in good academic standing
with their respective college or university. Students interested in an unpaid internship must have the College
Internship Coordinator write a letter of introduction which must include at least two preferred work locations to
serve the internship, the exact time frame and number of hours the intern wishes to serve each week, and the number
of credits the student expects to earn. Interns must be willing to work a minimum of 25 hours per week and must
earn college credit while participating in the program. All applicants are required to successfully pass a background
investigation. Students serving an internship within an ISP Forensic Science Laboratory are also required to
successfully pass a polygraph examination.
In order to be considered for the Illinois State Police Internship Program, the following must be completed and
submitted:
A sealed letter of introduction from the college Intern Coordinator or Department Chair;
A letter from the student indicating why they want to intern with the ISP;
An Illinois State Police Internship Application;
An Illinois State Police Authorization for Release of Personal Information;
An updated resume and employment history;
Three personal references to include primary and alternate telephone numbers and current addresses;
Two current passport-sized pictures;
An insurance liability waiver;
An Authorization Form for Employment Credit Report; and,
A Disclosure Statement for Employment Credit Report.
It is the responsibility of the student to advise the Recruitment Unit of any change of address, telephone number, or
withdrawal from the program at any time during the semester. The deadlines for submitting intern applications are
as follows:
Spring Semester September 30
Summer Semester January 31
Fall Semester April 30
If the application packet is not complete or received in the Recruitment Unit by the deadline, it may prevent the
student from being considered for an internship.
After applications are received, students are tentatively placed pending a thorough background investigation which
may occasionally be delayed. Students should remain in contact with the College Intern Coordinator and should not
report to the proposed work site until receiving confirmation from the Illinois State Police. Please call the
Recruitment Section at 217/785-4370 if you have any questions or need additional information. The Illinois State
Police is an Equal Opportunity Employer.
The completed internship application should be sent to the following address:
(Please do not fold the application or copy double sided)
Internship Program Manager
Illinois State Police Recruitment Unit
801 S. 7th St., Ste 100-S
Springfield, Illinois 62703
1
ILLINOIS STATE POLICE
INTERNSHIP PROGRAM GUIDELINES
All students considered for the Illinois State Police (ISP) Internship Program must be in good academic standing
with their respective college or university. Students interested in an unpaid internship must have the College
Internship Coordinator write a letter of introduction which must include at least two preferred work locations to
serve the internship, the exact time frame and number of hours the intern wishes to serve each week, and the number
of credits the student expects to earn. Interns must be willing to work a minimum of 25 hours per week and must
earn college credit while participating in the program. All applicants are required to successfully pass a background
investigation. Students serving an internship within an ISP Forensic Science Laboratory are also required to
successfully pass a polygraph examination.
In order to be considered for the Illinois State Police Internship Program, the following must be completed and
submitted:
A sealed letter of introduction from the college Intern Coordinator or Department Chair;
A letter from the student indicating why they want to intern with the ISP;
An Illinois State Police Internship Application;
An Illinois State Police Authorization for Release of Personal Information;
An updated resume and employment history;
Three personal references to include primary and alternate telephone numbers and current addresses;
Two current passport-sized pictures;
An insurance liability waiver;
An Authorization Form for Employment Credit Report; and,
A Disclosure Statement for Employment Credit Report.
It is the responsibility of the student to advise the Recruitment Unit of any change of address, telephone number, or
withdrawal from the program at any time during the semester. The deadlines for submitting intern applications are
as follows:
Spring Semester September 30
Summer Semester January 31
Fall Semester April 30
If the application packet is not complete or received in the Recruitment Unit by the deadline, it may prevent the
student from being considered for an internship.
After applications are received, students are tentatively placed pending a thorough background investigation which
may occasionally be delayed. Students should remain in contact with the College Intern Coordinator and should not
report to the proposed work site until receiving confirmation from the Illinois State Police. Please call the
Recruitment Section at 217/785-4370 if you have any questions or need additional information. The Illinois State
Police is an Equal Opportunity Employer.
The completed internship application should be sent to the following address:
(Please do not fold the application or copy double sided)
Internship Program Manager
Illinois State Police Recruitment Unit
801 S. 7th St., Ste 100-S
Springfield, Illinois 62703
1
APPLICATION FOR ILLINOIS STATE POLICE INTERNSHIP APPLICATION
ATTACH TWO
RETURN TO:
INTERNSHIP PROGRAM MANAGER
PASSPORT SIZED
ILLINOIS STATE POLICE RECRUITMENT
th
801 SOUTH 7
ST., STE. 100-S, SPRINGFIELD, ILLINOIS
PHOTOS HERE
62703
PLEASE INDICATE FOR WHICH SEMESTER YOU ARE APPLYING: SPRING ____SUMMER____FALL____
HAVE YOU PARTICIPATED IN THE ISP INTERNSHIP PROGRAM BEFORE
Y
N ? IF YES, WHEN?
PERSONAL DATA (TYPE OR PRINT
)
NAME: _____________________________________________________________________________________
(Last) (First) (Middle Initial)
Permanent Address: ____________________________________________________________________________
(Street)(City) (State) (Zip) (Phone)
Present Address: ______________________________________________________________________________
(Street)(City) (State) (Zip) (Phone)
Telephone Number(s): __________________________________________________________________________
Date of Birth:________________ Place of Birth: ____________________________________________________
Social Security Number:______________________ Race:______________ Sex: ___________________________
Driver’s License Number and State of Issuance: _____________________________________________________
Email Address: _______________________________________________________________________________
EDUCATION
College/University: ____________________________________________________________________________
Address: ____________________________________________________________________________________
(Street) (City) (State) (Zip)
Internship Coordinator: _________________________________________________________________________
Major:_____________________________________ Anticipated Graduation Date: _________________________
Degree(s): ___________________________________________________________________________________
Credit Hours Required to Complete Internship: ______________________________________________________
2
ISP 1-189 (9/18)
EMPLOYMENT RECORD (LIST ALL JOBS YOU HAVE HELD DURING THE LAST TEN
YEARS STARTING WITH THE MOST RECENT)
Employer: __________________________
Daytime Phone Number:_______________________
Dates Employed:___________________________________________________________________
Address:__________________________________________________________________________
City State Zip:_____________________________________________________________________
Reason for leaving:_________________________________________________________________
Employer: _____________________________Daytime Phone Number:_______________________
Dates Employed:___________________________________________________________________
Address:__________________________________________________________________________
City State Zip:_____________________________________________________________________
Reason for leaving:_________________________________________________________________
Employer:_____________________________ Daytime Phone Number:_______________________
Dates Employed:___________________________________________________________________
Address:__________________________________________________________________________
City State Zip:_____________________________________________________________________
Reason for leaving:_________________________________________________________________
Employer: _____________________________Daytime Phone Number:_______________________
Dates Employed:___________________________________________________________________
Address:__________________________________________________________________________
City State Zip:_____________________________________________________________________
Reason for leaving:_________________________________________________________________
REFERENCES (LIST THREE (3) PERSONAL REFERENCES OTHER THAN
IMMEDIATE FAMILY OR EMPLOYERS):
Name: ______________________________________________________________________________
Address: ____________________________________________________________________________
Daytime Phone Number: ________________________________________________________________
Name ______________________________________________________________________________
Address: ____________________________________________________________________________
Daytime Phone Number: _______________________________________________________________
Name: ______________________________________________________________________________
Address: ____________________________________________________________________________
Daytime Phone Number: _______________________________________________________________
3
AUTHORIZATION FOR RELEASE OF PERSONAL INFORMATION
For a period of one year from the execution of this form, I______________________________ authorize the State
of Illinois, Illinois State Police to conduct an investigation into all aspects of my qualifications and background. I
also authorize any individual, organization, or agency which maintains records relating to me to provide these
records on request to any agency of the Illinois State Police conducting such an investigation. This authorization
includes, but is not limited to, employment records, credit records, and criminal history records. The intent of this
authorization is to give my consent to full and complete disclosure of criminal records, internal investigation
records, military records, records of educational and financial institutions, employment and pre-employment
records, background reports, efficiency ratings, and complaints. I specifically waive my rights to written notice of
release of information relating to prior disciplinary actions, as provided by the Illinois Personnel Record Review
Act.
I also certify that any person(s) who may furnish such information concerning me shall not be held accountable for
giving this information; and I do hereby release such person(s) from any and all liability which may be incurred as
a result of furnishing such information whether from record or recollection. I further release the Illinois State
Police, its agents and designees under this release, from any and all liability which may be incurred as a result of
furnishing such information.
_________________________________
________________
Signature
Date
_________________________________
_______________________________________
Print Name
Maiden Last Name, former Married name(s) or
Other names used
_________________________________
______________________________________
Current Address
Previous Address
_________________________________
______________________________________
City / State / Zip
City / State / Zip
To process this form, the following information has been requested by the Illinois State Police:
_________________________________
_________________________________
Date of Birth
Social Security Number
_________________________________
_________________
Driver’s License Number
Sex / Race
4
Authorization for Appointment/Employment Credit Report
I authorize the Illinois State Police to obtain a credit report on myself through the credit reporting agency of its
choice.
_________________________________
________________
Signature
Date
_________________________________
Print Name
Employment Credit Report Disclosure Statement
The Illinois State Police will procure a credit report concerning my employment . If an adverse employment
decision is made due totally or partially to the information on the credit report, the Illinois State Police will provide
me a copy of the credit report, a summary of my rights under the Fair Credit Reporting Act, and the source of the
credit report so that I may contact them, if I wish.
_________________________________
________________
Signature
Date
_________________________________
Print Name
5

Download Form ISP 1-189 Application for Illinois State Police Internship Application - Illinois

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