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Employment History (List employment history beginning with current employer):  Employers Name: Phone: Employers Address:  (Street) (City) (State) (Zip) Position(s): From: To: Employers Name: Phone: Employers Address: (Street) (City) (State) (Zip) Position(s): From: To:  Honors Awards:  Extracurricular activities, hobbies, and/or organizations:   Internship Related Course Work: List all criminal justice and related classes you have completed. Include courses you are currently enrolled in (identified by *) and any special workshops, training session, or other criminal justice experience that relates to your internship request. List your classes by name not number.  Is there anything in your background that would preclude you from being acceptable to any of the agencies you are applying for? Yes No If yes, please explain.  References (List three references other than immediate family or employers): Name Complete Address Area Code + Phone # Relationship  1.  2.  3.   I acknowledge the information provided in this Student Information, Form VI, is true and correct and I understand that all information provided is subject to verification. 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