DCFS Internship Application

Contact Information
Background Information
Placement Information
Education Information
Disclaimers and Attachments

Contact Information
Background Information
Placement Information
Education Information
Disclaimers and Attachments

First Name

Middle Initial

Last Name

Street Address

City

State

ZIP/Postal Code

Home Phone

Cell Phone

Work Phone

University Email

Personal Email

How did you hear about the Academic Internship Program?

From which University/College or DCFS Employee or other did you hear about this program?

Are you a DCFS Employee?

Are you a current or former Youth in Care?

Do you have a valid driver's license?

Is English Your Primary language?

If English is not your primary Language, what is your Primary Language?

What other languages do you speak?

Birthday

You are under no obligation to reveal your date of birth. This information is for program statistical purposes only.

Gender

You are under no obligation to reveal your gender. This information is for program statistical purposes only.

Ethnicity

You are under no obligation to reveal your ethnicity. This information is for program statistical purposes only.

Desired Location 1

Please indicate the 1st County in which you are willing or able to perform your fieldwork. Only Counties where DCFS offices are loated are listed.

If Desired Location 1 is Cook County, Desired Office Location 1

Desired Location 2

Please indicate the 2nd County in which you are willing or able to perform your fieldwork. Only Counties where DCFS offices are loated are listed.

If Desired Location 2 is Cook County, Desired Office Location 2

If Location 1 or 2 are not availaible. Would you be willing to accept an internship at an alternate location?

Desired Specialty of Placement

Name of Institution/University

Department/Program Currently Enrolled In

Student Status

Year in School

Enrolled in a Child-Welfare Specialization Program?

Major

Degree Sought

Expected Graduation Date

University Field Director/Placement Liaison Name

University Field Director/Placement Liaison Phone

University Field Director/Placement Liaison Email

Is fulfilling an internship a program requirement?

Total Internship Clock Hours Required

University Deadline for Placement Approval

Anticipated Start Date for Field Placement

Anticipated End Date for Field Placement

Have you ever been convicted of a crime (other than a misdemeanor traffic violation)?

If yes, please provide a description of the specific crime(s) and dates on a separate sheet.

You must read the full statement, scrolling to the bottom of each disclaimer before being able to acknowledge your agreement.

Automobile Use

I understand that if I use my personal car in carrying out assignments related to my learning objectives, I must hold a valid driver's license, current automobile liability and comprehensive automobile insurance and agree to complete and submit to the regional business office the form used to certify my license and my automobile insurance. I have also submitted a copy of my driver’s license and insurance with this application. I further understand that transporting clients is not acceptable as an intern assignment and is not reimbursable. If I transport clients I do so as a volunteer and understand that I hold all liability for mishaps.

Yes, I agree.

Background Check

Because of the nature of the work of DCFS, I understand that each prospective intern must clear a finger-print based background clearance including a CANTS check (Child Abuse and Neglect Tracking System) SOR check (Sexual Offender Registry) and an Illinois State Police/FBI background check including use of LEADS. I understand that I would not be eligible to be an intern at DCFS if the CANTS or SOR indicates I am an indicated perpetrator in either system. I agree to cooperate with authorizations for DCFS to complete these background checks and to conduct/coordinate my fingerprinting through the DCFS Office of Training, Field Placement/Internship Program.

Yes, I agree.

Waiver of Liability

I, being eighteen years of age or older and of sound mind do hereby affirm as follows: 1. I have voluntarily chosen and elected to participate in an internship at the Illinois Department of Children and Family Services. 2. I am fully aware of potential risk of harm which may arise in the course of this internship. 3. I willfully and freely assume complete responsibility for any injuries, physical or mental, which I might sustain by participating in a placement through the Professional Degree Field Placement Program at IDCFS. 4. I have made provisions through the University/College or my parents to have medical insurance sufficient to cover any medical obligations resulting from internship or emergencies onsite and give permission to allow DCFS to call for emergency care for me if appropriate. 5. I understand that it is my responsibility to arrange for registration of school credits for this internship and facilitate communication between school and field instructor as needed to provide this internship in line with rules and guidelines for each institution. 6. I will hold Illinois Department of Children and Family Services (IDCFS) harmless and not liable for any injury which may befall me as a result of my participation in the program.

Yes, I agree.

Release of Claims

By clicking "Submit" on this application, the student intern hereby releases and forever discharges the Illinois Department of Children and Family Services, its employees and subdivisions from all claims and demand of any nature arising from this internship or any activities related to this internship.

Yes, I agree.

Please Note: The following attachments are required or your application will not be processed.

Cover Letter
Resumè

IF you answered Yes to conviction of a crime, you must also attach a description of the specific crime(s) and dates.

Supported file formats:

DOC, DOCX, GIF, JPG, ODT, PDF, PNG, RTF, TIF, TXT

Filename cannot start with period (.), contain the following characters \ / : * ? " < > | ; % $, or contain special filenames reserved for Windows OS like nul, prn, con, lpt, or com.

Attachments

Multiple files can be uploaded