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Blue Earth County Probation Department Volunteer / Intern Application
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This form has been modified since it was saved. Please review all fields before submitting.
Steps
1.
Position
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2.
Personal Information
This section is complete
This section is incomplete
3.
Availability
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4.
Employment History
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This section is incomplete
5.
Education History
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6.
Volunteer Experience
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This section is incomplete
7.
Background
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This section is incomplete
8.
References
This section is complete
This section is incomplete
Position
Position applying for
Please select one of the following:
Internship
Volunteer
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Personal Information
Please be aware, should your application be selected you will be required to provide your social security number.
Last Name
First Name
Middle Name
Date of Birth
Email Address
Street Address
City
State
Zip Code
Daytime Phone #
*
Evening Phone #
Cell Phone #
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Availability
Dates you plan to volunteer:
From
*
To
*
Number of hours you plan to volunteer for:
Hours per
Week
Month
When are you available?
Monday
Friday
Tuesday
Saturday
Wednesday
Sunday
Thursday
Special Circumstances
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Employment History
Enter most recent first
Employer Name and Address
Telephone
Dates Employed
From
To
Name of Supervisor
Job Title
May we contact this employer?
Yes
No
Description of Duties
Reason for Leaving
Employer Name and Address
Telephone
Dates Employed
From
To
Name of Supervisor
Job Title
May we contact this employer?
Yes
No
Description of Duties
Reason for Leaving
Employer Name and Address
Telephone
Dates Employed
From
To
Name of Supervisor
Job Title
May we contact this employer?
Yes
No
Description of Duties
Reason for Leaving
Employer Name and Address
Telephone
Dates Employed
From
To
Name of Supervisor
Job Title
May we contact this employer?
Yes
No
Description of Duties
Reason for Leaving
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Education History
High School
Name and Location
Subjects Studied
Degree and Graduation Date
or # of years completed
College/University/Technical/Vocational School
Name and Location
Major/Minor
Degree and Graduation Date
or # of years completed
Graduate School or other post-graduate education
Name and Location
Area of Study
Degree and Graduation Date
or # of years completed
Other Training/Courses
Areas of Training/Study
Degree and Graduation Date
or # of years completed
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Volunteer Experience
Agency/Organization and Address
Telephone
Dates Volunteered
From
To
Name of Supervisor
May we contact this Agency?
Yes
No
Reason for Leaving
Job Title and Duties
School Name
School Address
Internship Advisor
Advisor's Phone
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Background
Do you have a valid driver's license?
Yes
No
If yes, state and license #
Available car?
Yes
No
If yes, name of insurance company
Do you have any physical or mental condition(s) which would limit your ability to participate in activities with Blue Earth County Community Corrections?
Yes
No
A physical or mental condition(s) does not disqualify a volunteer. This data is required to determine how to accomodate any special needs.
If yes, please explain (limitation(s), activity restriction(s), etc.)
Have you ever been convicted of a criminal offense (including petty misdemeanors) or major traffic offense (misdemeanor or greater)?
Yes
No
Report all convictions past and present.(Convictions may not automatically disqualify you.)
If yes, what was your offense?
Include the conviction date and end date of probation/parole or court jurisdiction.
Are you now or have you ever been placed on probation or participated in a diversion program?
Yes
No
If yes, please explain
Has any member of your family, a friend or acquaintance, ever been supervised on probation or diversion by this agency?
Yes
No
If yes, please explain
Are you currently involved in a court matter in Minnesota or any other jurisdiction?
Yes
No
If yes, please explain
Do you have any close friend or family member under any type of court jurisdiction, and/or in any correctional/placement/institution/facility?
Yes
No
This will not disqualify you.
If yes, please list name(s) and relationships
Are you now or have you ever been involved with child protection or social services authorities in Blue Earth County or any other jurisdiction?
Yes
No
If yes, list dates and circumstances
List where you have lived the past five (5) years other than Blue Earth County
Have you ever been asked to resign or been terminated by an employer or a volunteer training program?
Yes
No
If yes, please explain
Records checks will be done on all volunteer applicants. A conviction does not disqualify a volunteer. It is generally necessary for a person to have made a satisfactory community adjustment for at least one year and/or subsequent completion of probation before acceptance is considered.
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References
References will be checked.
Reference 1
Name
Address
Telephone
Relationship
Years Known
Reference 2
Name
Address
Telephone
Relationship
Years Known
Reference 3
Name
Address
Telephone
Relationship
Years Known
Blue Earth County Community Corrections acknowledges that equal opportunity for all persons is a fundamental human value. The volunteer program considers each applicant on the basis of individual ability and merit, without regard to race, color, creed, age, religion, national origin, sex, handicap, sexual orientation, marital status or public assistance status.
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