__________________________________________ _______________________
Have you ever pled nolo contendere or pled guilty to a crime which is a first degree misdemeanor or felony?
(If yes, provide the charge(s), where and the dates) Yes No
Charges:
Where:
Dates: ___________________________________
Have you ever had the adjudication of guilt withheld for a crime which is a first degree misdemeanor or felony?
(If yes, provide the charge(s), where and the dates) Yes No
Charges:
Where:
Dates: ___________________________________
Notification and Agreement
(Please read before signing)
I certify that all answers given by me are true, accurate, and complete. I understand that the falsification,
misrepresentation or omission of facts on this application (or any other required documents) will be cause for denial,
regarding of when or how discovered. I consent to the release of information about my ability, employment history,
and fitness for employment by employers, schools, law enforcement agencies, and other individuals and
organizations to investigators, personnel staff, and other authorized employees of Florida state government for
employment purposes. This consent shall continue to be effective during my internship.
Signature of Intern Date
Required documentation:
• Application
• Cover letter
• Resume
• Official Transcript
• Letter(s) of Recommendation (At least one letter from Academic Advisor or Professor in the area of study.)
Plea
se email this form and required documents to: DEP_Internships@dep.state.fl.us
You may also print a copy and mail to:
Department of Environmental Protection, Bureau of Human Resource Management ATTN: Terry
Shine, Employee Relations
3900 Commonwealth Blvd., MS# 70, Tallahassee, Fl. 32399
Or send via fax at 850-412-0704 - ATTN: Employee Relations - Internships
DEP Internship Application (05-15-2015)
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