Internship Application - Dept. of Probation

If you are interested in an internship with the Cattaraugus County Department of Probation and Correctional Alternatives then please complete the following form. Please contact us with any questions at 716-373-8047.

Your Name

First

Middle

Last

Suffix

Aliases

Phone Number

Email Address

Please enter your email address again

Home Address

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

School Address

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Emergency Contact

Emergency Contact Name

First

Middle

Last

Suffix

Phone Number

Emergency Contact Address

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Is this internship required?

Educational Institution

Stage of College

Required Hours to be Completed

Dates or semester for internship to take place

Internship Advisor/Professor (Please list name, phone, email, Fax #):

Please list any requirements

Do you have any family members or other associations that are under Probation Supervision with this department?

Please list their name(s) and relationship to you:

Have you ever been arrested, adjudicated or convicted of a crime?

Please list your previous legal involvement (crime, dates, court, disposition):

Do you currently have any pending matters in Court at this time?

Please list your current involvement (crime, court, next court date, current status)