Anne Arundel County Government
Internship Application
Applications are accepted at the Office of Personnel Monday - Friday between the hours of 8:00 a.m. and 4:30 p.m.
Instructions: Answer every question completely. Do not substitute resumes or other kinds of applications for an official Anne Arundel County
Government Internship Application. Please type or print clearly using black ink.
Application for intern of: (Specify Department Interest)
1. Name
(Last) (First) (Middle)
3. Address 4. Phone Numbers/E-Mail Address
Home Phone:
(Number) (Street) (Apt. #)
Work Phone:
(City) (State) (Zip) E-Mail:
5. Whom shall we contact in case of an emergency?
I understand that I must notify the Office of Personnel of any
change in my name, address, phone number or other pertinent Name:
information. Phone:
6. Are you currently a Probationary Employee in
the County Classified Service? No Yes If yes, date of hire:
7. From:
Are you an active Anne Arundel County Volunteer Fire Fighter?
No Yes To:
8. Did you graduate from high school? Yes No 8a. Do you have a GED? Yes No
Name: Number:
Address: State:
9. Name and location of college(s) or Total Credit Degree
Major Field Degree Type Years Attended
university(ies) attended Hours /Date
10. Other Training: Describe any specialized training (trade school, military training, law enforcement training, or specialized schooling) which you
have which may be relevant to this position. Include any licenses and certifications with numbers and expiration dates, if available.
Certificate or Expiration
Trade School/Organization Name Type of Training Describe
License Date
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11a. Other Skills or Abilities: Please describe your proficiency/skill/ability in the use of computer hardware and software, equipment/tools, or any
other special skills or abilities that enhance your qualification for this position. Only include those skills that you currently use or have
maintained, and identify how you use those tools.
Specific Tool/Equipment/ Proficiency Level How Used
Specific Skill or Ability
Hardware/Software (Advanced/Intermediate/Beginner) (Application)
11b. Language Skills: Please describe your proficiency/skill in foreign or sign languages as identified below. For skill level please choose excellent,
good or fair under reading, speaking, understanding, and writing:
Reading Speaking Understanding Writing
Language
(Excellent/Good/Fair) (Excellent/Good/Fair) (Excellent/Good/Fair) (Excellent/Good/Fair)
12. Experience:
Use the following blocks A and B to provide complete information about your previous jobs Starting With Your Present or Most Recent
Position in Block A. Include all relevant paid, non-paid, volunteer and military experience. List Promotions as Separate Jobs. You must
provide all of the information requested for each job you list. If you require more space to answer Blocks A and B, or if you require more blocks
to list all of your previous jobs, attach additional pages that provide all of the information requested for each job. Your resume should be used
only to supplement information presented in these blocks. Label all additional pages with your Name, Social Security Number.
A
Position Title: Current Position? Yes No Employer: (Company or Organization)
Name, Title, and Telephone Number of Immediate Supervisor: Address of Employer:
Dates of Employment: Describe your duties, responsibilities and accomplishments below. Be
From To descriptive.
Last Salary Per
Type of Business
Number of Hours Worked Per Week
Number of Employees You Supervised
Reason for Wanting to Leave
B
Position Title: Current Position? Yes No Employer: (Company or Organization)
Name, Title, and Telephone Number of Immediate Supervisor: Address of Employer:
Dates of Employment: Describe your duties, responsibilities and accomplishments below. Be
From To descriptive.
Last Salary Per
Type of Business
Number of Hours Worked Per Week
Number of Employees You Supervised
Reason for Wanting to Leave
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13. Are you a citizen of the U.S. or are you otherwise legally eligible for employment in the U.S.? Yes No
Anyone offered employment is required to provide proper identification and documentation of eligibility for employment in the U.S.
14. Do you have a valid motor vehicle operators license? Yes No
License Number: Class State
Is this license a Commercial Driver's License? Yes No Endorsement Code:
Where Required By The Announcement, Failure To Provide License Number May Result In Disqualification.
15. Have you ever been convicted of a criminal offense in any court? Yes No
(Exclude expunged convictions unless applying for a law enforcement position)
If yes, give date, place, charge, court and fine, sentence or conviction.
A conviction does not automatically mean that you will not be employed. The nature of the offense and when it occurred will be
considered. Give all the facts so that a decision can be made. (Attach additional sheets, if necessary, and label all additional sheets with
Name, Social Security Number and Job Announcement Number.)
16. Have you ever been fired or asked to resign from a job? Yes No
If yes, give date, name and address of employer, and reason.
A firing or forced resignation does not automatically mean that you will not be employed. The circumstances, time elapsed and recent
employment record will be considered. Give all the facts so that a decision can be made. (Attach additional sheets, if necessary, and label
all additional sheets with Name, Social Security Number and Job Announcement Number.)
17. The following notice applies to everyone except applications for Law Enforcement Officer positions as defined by Article 27,
Section 727, or any employee of any law enforcement agency of the State of Maryland or any county, incorporated city or
town, or other municipal corporation.
"Under Maryland Law An Employer May Not Require Or Demand Any Applicant For Employment Or Prospective
Employment Or Any Employee To Submit To Or Take A Polygraph, Lie Detector Or Similar Test Or Examination
As A Condition Of Employment Or Continued Employment. Any Employer Who Violates This Provision Is Guilty
Of A Misdemeanor Subject To A Fine Not To Exceed $100."
Signature of Intern Date
(Required by Maryland State Law)
I hereby certify that every statement I have made in this application is True and Complete to the best of my knowledge. I
understand that any false or incomplete answer may be grounds for not receiving this internship. I understand that I may
have to pass a physical examination; produce documentation verifying identity and employment in the U.S.; and be fingerprinted
as a condition of my employment.
I hereby authorize and fully consent to the disclosure and release to Anne Arundel County, Maryland of any information and
documents bearing on my academic history; job performance; and/or other credentials or licenses that may be relevant to the
Internship for which this application is made. It is my specific intent to provide access to the above-detailed information, no
matter how personal or confidential it may appear to be. In consideration of Anne Arundel county's acceptance and evaluation of
this application, I hereby release and hold harmless Anne Arundel County, Maryland; any school; any present or former
employer; and/or any other person furnishing such information or documents.
Photocopies of this authorization, and of my signature hereon, shall be deemed to provide the same release as my original
signature.
Signature of Intern Date
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Anne Arundel County
Office of Personnel
Anne Arundel County seeks the following information in order to comply with its obligations under all applicable Equal
Employment Opportunity Laws. Individuals are encouraged to complete this form which is detached from the application and
used for statistical purposes only. Those who choose not to provide race or sex information will be placed in the largest applicant
group. In keeping with Anne Arundel County policy, any individual who knowingly falsifies a race or sex claim is subject to
disqualification or termination.
A. How did you first learn about the job for which you are applying? (Please specify one.)
a. Newspaper (name) i. Job Fair/Conference (where/when)
b. Job Bulletin (where posted) j. College/University/School (name)
c. Federal/State Employment service (name) k. County Telephone Jobline
d. Community Action Agency (name) l. Other (specify)
e. Magazine/Journal (name) m. Television (station)
f. Walk-In (where) n. Radio (station)
g. County Employee (name) o. County Internet Website
h. Notification Postcard p. Internet Website, Other
B. Date of Birth: C. Sex:
/ / Male Female
(Month) (Day) (Year)
D. Ethnic Origin:
The U.S. Equal Employment Opportunity Commission (EEOC) has defined the following categories of ethnic origin. Please check
which best describes your ethnic origin.
White (Not of Hispanic origin) : All persons having origins in ay of the original peoples of Europe, North Africa, or the
Middle East.
Black (Not of Hispanic origin) : All persons having origins in any of the Black racial groups of Africa.
Hispanic: All persons of Mexican, Puerto Rican, Cuban, Central or South American, or other Spanish culture or origin,
regardless of race.
Asian or Pacific Islander: All persons having origins in any of the original peoples of the Far East, Southeast Asia, the
Indian Subcontinent, or the Pacific Islands. (For example: China, Japan, Korea, the Philippines, and Samoa.)
American Indian or Alaskan Native: All persons having origins in any of the original peoples of North America, and who
maintain cultural identification through tribal affiliations or community recognition.
Anne Arundel County is an Equal Opportunity Employer. Females, Minorities, and Individuals with Disabilities are
Any disabled applicant who needs a reasonable accommodation during the application or testing process should notify the
Office of Personnel in advance at 410-222-7595.
Return To: Mail To:
Anne Arundel County Government Anne Arundel County Government
Office of Personnel Office of Personnel
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2660 Riva Road, Heritage Complex Post Office Box 6675
Annapolis, Maryland 21401 Annapolis, Maryland 21401
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