Juvenile Justice Specialist Intern
Application

 

Last Name: ____________________________________________

First Name: ___________________________________ MI: ______

Address: ______________________________________________

County: _______________________________________________

City: __________________________________________________

State: _____________________ Zip Code: ___________________

Phone: (____)______-____________ (____)______-____________

Social Security #: _______________-___________-_____________

Date of Birth: ______________/_______________/_____________

Drivers' License #: _______________________________________

Race: (circle one) White
Black
Native American
Asian American
Hispanic
   
Sex: (circle one) Male / Female

Degree: _______________________________________________

Major: ________________________________________________

 

Please complete this form, print and mail to:

Department of Juvenile Justice Central Screening
707 N. 15th St.
Springfield, Illinois 62702

or fax: (217) 557-1107

close this browser window to return to the Department of Juvenile Justice website