To:
Applicants for Criminal Justice Internship Program
From:
Police Chief John D. Corn
Subject:
Application Process
PLEASE READ THE FOLLOWING GUIDELINES CAREFULLY BEFORE COMPLETING THE
APPLICATION FORMS. THESE GUIDELINES ARE STRICTLY ENFORCED AND ADHERED TO.
1. Meet with your schools program advisor and receive approval to participate in the
Internship Program.
2. Obtain a Criminal Background check from the Oklahoma State Bureau of Investigation
(OSBI). This will be attached to your application packet. The OSBI background cannot
be more than six (6) months old from the time of application. The cost for the
background is the applicants’ responsibility.
3. Complete the attached application. Neatly print the information in the space provided.
If additional space is needed, please attach a separate piece of paper and ensure that
the page and question number are next to the information.
4. Submit the completed application, background investigation, photocopy of drivers’
license, a schedule outlining your availability to complete the internship within the
required time frame. Please take into consideration your school, work and family
schedules. Also include a copy of any evaluation tool used by your school within sixty
(60) days of the start of the internship to:
Yukon Police Department
Attn: Chief of Police
100 South Ranchwood Blvd.
Yukon, Oklahoma 73099
5. You will be contacted by the Chiefs office about an interview. During this interview you
will meet with the Chief about the goals and objectives of your internship.
(PLEASE PRINT)
Date of Application: _______________
Personal Information
Last Name: _________________
First Name: ____________
Middle Initial: _____
Mailing Address: ____________________________________________________
City: ________________
State: _________
Zip Code: ___________
Phone Numbers: ______________________
Primary
_________________________
Secondary
Emergency Contact: ___________________
Phone Number: ____________
References
Give name, address and phone number of three (3) references who are not related to you and are not
previous employers:
1.
2.
3.
_________________________________
_________________________________
_________________________________
Phone Number: ____________
Phone Number: ____________
Phone Number: ____________
Education
Name of High School: __________________________
Graduate or GED Year: _________
Name of College / University: ___________________
Years Completed: 1 2 3 4 5
___________________
Years Completed: 1 2 3 4 5
Major or Degree Obtained: _____________________
Minor: _____________________
School Sponsoring Internship: ________________
Proposed Start Date: _____________
Advisor: __________________
Proposed End Date: _______________
Area of Interest:
Detective Division, Patrol Division, Communications Division, Other: _____________________
Employment History
Current Employer: ________________________________
Phone Number: ______________
Address: _________________________________________
City: __________
State: _____
Supervisor: _____________________________________
Position: ______________________
Responsibilities: __________________________
Past Employer: ___________________________________
Phone Number: ______________
Address: ________________________________________
City: __________
State: _____
Supervisor: _____________________________________
Position: ______________________
Responsibilities: __________________________
Skills and Qualifications
Please summarize skills, qualifications, certifications or licenses you may have that would
enhance your qualifications for a career in law enforcement.
_______________________________________________________________________
_______________________________________________________________________
List languages other than English that you speak proficiently, including communicating with the
hearing impaired.
_______________________________________________________________________
_______________________________________________________________________
Additional Information
Please state any additional information that you feel may be helpful to us in considering your
application for the Law Enforcement Internship Program.
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
NOTICE TO APPLICANTS
Read Carefully Before Signing
I certify that answers given herein are true and complete to the best of my
knowledge. I understand that false or misleading statements / answers will
disqualify me for participation in the Internship Program.
The background information supplied by the applicant will be checked. This
check will cover the accuracy of the data furnished and the past performances
record of the candidate. I hereby authorize the Yukon Police Department to
investigate all statements contained in this application and verify the facts
claimed by me on this application. I understand that such information is
confidential, and the Police Department cannot reveal the reason for rejection.
I understand that false or misleading statements given in my application or
interview may result in removal from the Internship Program even after
accepted.
I further understand and agree that my participation in the Law Enforcement
Internship Program with the Yukon Police Department does not constitute any
form of employment with the City of Yukon.
I hereby grant permission to the Yukon Police Department to investigate and
verify any information included in this application.
_______________________________
Signature of Applicant
______________
Date
AUTHORITY TO RELEASE INFORMATION
TO WHOM IT MAY CONCERN:
I hereby authorize any representative from the Yukon Police Department
bearing this release, or a photo copy thereof, within one (1) year of its date, to
obtain any information from your files pertaining to my employment records
including, but not limited to, attendance, employment history and disciplinary
records. I hereby direct you to release such information upon request of the
bearer.
This release is executed with full knowledge and understanding that the
information is for the express use of the Yukon Police Department.
I hereby release you as the custodian of such records and, any school, college or
university or other education institution, including its officers, employees or
related personnel both individually and collectively, from any and all liability
for damages of whatever kind which may at any time result to me because of
compliance with this authorization and request to release information, or any
attempt to comply with it.
A copy of tis authority to release will be as valid as the original. Should there be
any question as to the validity of this release, you may contact me as indicated
below.
___________________________________
Signature of Applicant
_______________
Date
TYPE or PRINT:
Full Name: __________________________________________
Address: ____________________________________________
City: ______________________
State: __________
Phone Number: _______________________
Zip Code: ____________
READ THIS DOCUMENT COMPLETELY BEFORE COMPLETING
THIS FORM IS TO BE SUBMITTED NO MORE THAN 5 DAYS PRIOR TO THE REQUESTED RIDE DATE
I ______________________________, hereby submit a voluntary request to ride as a passenger in a Yukon Police Department
vehicle, subject to the provision indicated below.
AGREEMENT ASSUMING RISK OF INJURY OR DAMAGE
WAIVER AND RELEASE CLAIMS
Whereas the undersigned, not being a member, employee or agent of the Yukon Police Department has made a
voluntary request for permission to ride as a guest passenger and observer in a Yukon Police Department vehicle during a time
when such vehicle is to be operated by an officer of the Yukon Police Department during the active performance of his/her
official police duties;
And whereas the undersigned acknowledges that the work and activities of the Yukon Police Department are
inherently dangerous, involving possible risk of injury, or loss to person or property;
Now therefore, be it understood that the undersigned, and his/her parent or guardian, if under the age of eighteen
(18) years, hereby agree that the City of Yukon, the Yukon Police Department, any officer of the Yukon Police Department, their
sureties and each of them shall not be held liable or responsible under any circumstances whatsoever by the undersigned,
his/her estate or heirs for any injury, death damage expense or loss to the person or property of the undersigned incurred
while riding as a passenger or observer in the Yukon Police Department vehicle or while accompanying an officer of the Yukon
Police Department during the active performance of his/her duties as a police officer.
Further, I hereby and by this document do release, demise and forever discharge the City of Yukon, the Yukon Police
Department, any agents servants, employees or independent contractors of the City of Yukon, mechanics and maintenance
personnel, in connection in any manner whatsoever with any accident, injuries or death which might occur during the tour of
duty indicated below with the Yukon Police Department.
Print Full Name:_________________________Address:________________________________________________
Street
City
Phone: (
State
)____________________________Date of Birth___/___/___ Age:___ OLN/SSN:___________________
Requested Officer: ______________________ Date(s) to Ride:_______________ Time(s):_____________a.m./p.m.
Reason for Request :






Certified Officer/Name of Agency___________________________________________________________
Student (please provide school and field of study)______________________________________________
Friend: _____Yes _____No
Relationship to officer if any:_______________________________________________________________
Affiliation with YPD (CPAA, TRIAD, NHW): ____________________________________________________
Other:_________________________________________________________________________________
I HAVE READ AND DO HEREBY CONCUR AND COMPLY WITH THE STIPULATIONS SET FORTH ABOVE. I ALSO CERTIFY THAT I HAVE NOT EVER
BEEN CONVICTED OF A CRIME AND THAT I AM NOT WANTED IN CONNECTION WITH ANY CRIME, NOR AM I UNDER INDICTMENT FOR ANY
CRIME BY ANY LAW ENFORCEMENT AGENCY OR CRIMINAL JUSTICE ENTITY.
Signature__________________________________________________
Date_______________________
Signature of Parent or Guardian________________________________
Date_______________________
Subscribed and sworn to before me on this the _____________ day of ___________________________, Year of ____________
Notary ___________________________________ Notary expires: __________________ Commission number______________
Chief of Police Signature:____________________________ Date_______________
Approved:
Yes
No