GEORGIA STATE BOARD OF PARDONS AND PAROLES

INTERNSHIP APPLICATION PACKAGE

2 Martin Luther King, Jr. Dr. S.E.

Suite 1116
West Tower
Atlanta, Georgia 30034
(404) 656-5716
 GEORGIA STATE BOARD OF PARDONS AND PAROLES
Qualifications

The following qualifications must be met before an intern assignment can be made:

1. The applicant should be a United States citizen or a lawful alien.

2. The applicant should be a student in good academic standing at his/her

college/university with a minimum Grade Point Average (G.P.A.) of 2.5.

3. The applicant must be a junior, senior, or graduate level student at an

accredited college/university.

4. The applicant should be pursuing a major in one of the following disciplines:

Criminal Justice, Psychology, Sociology, Social Work, Political Science,
Human Resources, Accounting, Finance, Business Administration, Computer
Science or Public Administration.

5. The applicant should be recommended by a faculty member.

6. The applicant shall provide a letter from his/her school’s registrar stating the
applicant’s current G.P.A. and academic grade level.

7. The applicant should be physically able to perform the duties of a Parole

Officer if applying for a P.O. internship.

8. Careful consideration will be given to any criminal history the applicant might
have. The applicant should have no criminal history of offenses involving
moral turpitude nor a pattern of disregard for public safety.
 GEORGIA STATE BOARD OF PARDONS AND PAROLES
Letter of Recommendation

TO BE COMPLETED BY APPLICANT

Name:

College/University:

Applicant’s degree program:

Overall GPA:

TO BE COMPLETED BY ADVISOR/FACULTY MEMBER

Name (please print):

Signature: Date:

Title:

Organization:

City, state, zip code:

Phone number (optional):

PLEASE COMMENT ON THE ACADEMIC PREPARATION AND CHARACTER OF APPLICANT

For additional space, please use back side of this sheet.

 GEORGIA STATE BOARD OF PARDONS AND PAROLES
Internship Application

Date

Full Name Social Security Number Date of Birth

Address City State

( ) ( )
Zip Code County Home Phone Number Work Phone Number

Race Sex Birth Place

OFFICE ASSIGNMENT

Please list the department you would like to intern in. If seeking a Parole Officer internship choose
three Parole Offices in which you would like to intern (refer to attached list).

1. 2. 3.

EDUCATION

Branch Major Minor Quarter/Semester Hours

( )
GPA Graduation Date Faculty Advisor Telephone Number

EMPLOYMENT (Most Recent)

Employer Address

( )
Telephone Number Supervisor Job Title Dates of Employment

Have you ever been dismissed from a job? If yes, explain

Have you ever worked as an intern for our agency? If so, what location?
 GEORGIA STATE BOARD OF PARDONS AND PAROLES
Internship Application

CRIMINAL RECORDS:

Have you ever been arrested for any reason?

If yes, explain

Have you ever been convicted by Federal, State, or other law-enforcement authorities, for any violation of any
Federal law, county or municipal law, regulation, or ordinance? (Do not include anything that happened before
your sixteenth birthday. Do not include minor traffic violations for which a fine of $35.00 or less was imposed. All
other convictions must be included even if they are pardoned.) Yes No If the answer is
YES, state the reason convicted, the date convicted, and the place where convicted

Charge on which convicted Date Convicted Name of Court/ Place Convicted Pardoned
(yes or no)

Are there any charges now pending against you by Federal, State, or other law-enforcement authorities, for any
violation of any Federal law, State law, county or municipal law, regulation or ordinance? (Do not include
anything that happened before your sixteenth birthday. Do not include minor traffic violations for which a fine of
$35.00 or less would likely be imposed.) Yes No If the answer is YES, provide the
following information.

Violation Charged Name of Government Name of Court/Location Pending

Do you have contact with any convicted felons at the present?

If yes, explain

MILITARY SERVICE

Branch Dates Type of Discharge

 GEORGIA STATE BOARD OF PARDONS AND PAROLES
GCIC Awareness Statement

Access to criminal justice information, as defined in GCIC Council Rule 140-1-.02 (amended), and
dissemination of such information are governed by state and federal laws and by GCIC Council Rules.
Criminal justice information cannot be accessed or disseminated by any employee except as directed
by superiors and as authorized by approved standard operating procedures which are based on
controlling state and federal laws, relevant federal regulations, and the Rules of the GCIC Council.

O.C.G.A. §35-3-38 establishes criminal penalties for specific offenses involving obtaining, using, or
disseminating criminal history record information except as permitted by law. The same statute
establishes criminal penalties for disclosing techniques or methods employed to ensure the security
and privacy of information or data collected in Georgia criminal justice information systems.

The Georgia Computer Systems Protection Act (O.C.G.A. §16-9-90 et seq.) was enacted to provide
statutory protection for public sector and private sector computer systems, including communications
links to such computer systems. The Act establishes major felony penalties for four criminal offenses:
Computer Theft, Computer Trespass, Computer Invasion of Privacy, and Computer Forgery. The Act
defines each of the felonies in broad terms. Criminal penalties for each offense include maximum
sentences to confinement for 15 years, fines up to $50,000, and civil penalties. The Act also
establishes Computer Password Disclosure as a misdemeanor, with the first violation punishable by
a fine of not exceeding $5,000 or imprisonment for not more than 12 months, or both.

These statutes have broad application in Georgia to private citizens, to public officials, and to
employees of government agencies. The Georgia Criminal Justice Information System Network,
operated by the Georgia Crime Information Center in compliance with O.C.G.A. §35-3-31, and all of
the data bases accessible via network terminals, are protected by the Computer Systems Protection
Act. Similar communications and computer systems operated by municipal/county governments are
also protected by the Act.

By my signature below, I acknowledge that I have read this Awareness Statement.

______________________________ _____________________________
Employee Name (print or type) Employee Signature

_______________________________ _______________________________
Signature, Witness Date
 GEORGIA STATE BOARD OF PARDONS AND PAROLES
Affidavit of Verification

Georgia, __________________ County

Personally appeared before the undersigned attesting officer, duly authorized to administer oaths,
_______________________, who, after being duly sworn, deposes and says and declares under
penalties of false swearing that he/she is the person who executed the forgoing instrument; that he/she
has read and completed the same and knows and understands the contents thereof; that the matters
stated therein and the answers and information furnished by him/her in the foregoing questionnaire,
including any attachments thereto, are true and correct. I understand that knowingly providing false
information in this application may be grounds for refusal or withdrawal of an offer of internship.

___________________________________
(SIGNATURE OF AFFIANT)

SWORN AND SUBSCRIBED BEFORE ME:

THIS____________ DAY OF _______, 20_____.

________________________________________
(NOTARY PUBLIC)

________________________________________
(EXPIRATION DATE OF COMMISSION)
 GEORGIA STATE BOARD OF PARDONS AND PAROLES
Waiver to Release Information

I, _______________________________, for the purpose of an intern background review being

conducted by the Georgia Board of Pardons and Paroles, authorize the release of all information, of
every sort and type, pertaining to my educational record, military service, employment history, driving
record and credit record, from any available source. I further authorize the release of any criminal
history record information pertaining to me which may be in the files of any criminal justice agency
whether federal, state, or local. I authorize the release of any and all information described above to
any designated representative of the Georgia Board of Pardons and Paroles.

A photo copy of this form may be used in lieu of the original.

This release is valid for sixty days.

Full Name Printed

Address

__________ __________ ___________

Sex Race Date of Birth Social Security Number

Drivers License Number

_______________________________________ ________________________
Signature Date

SUBSCRIBED BEFORE ME:

THIS __________ DAY OF ________________________, 20______

_______________________________________
(Notary Public)

____________________________________
EXPIRATION DATE OF COMMISSION
 Georgia Parole Board District Offices
Adairsville Conyers Fitzgerald
14 Legacy Way, Suite D 997 Commerce Dr., Suite 1-B 410 South Sherman Street
Adairsville, GA 30103 Conyers, GA 30094 Fitzgerald, GA 31750
(770) 773-2803 (770) 388-5770 (229) 426-5223

Albany Cordele Gainesville

1301 Evelyn Avenue 1207 South 7th Street 212 Green Street, N.E.
Albany, GA 31705 Cordele, GA 31015 Gainesville, GA 30501
(229) 430-4392 (229) 276-2363 (770) 535-5725

Americus Cuthbert Griffin

710 Martin Luther King Jr. Blvd. 301 East Dawson Street 1435 N. Expressway, Suite 301
Americus, GA 31719 Cuthbert, GA 39840 Griffin, GA 30223
(229) 931-2531 (229) 732-9575 (770) 229-3120

Athens Dahlonega Hartwell

434 East Dougherty Street 109 Tipton Drive 331 Memorial Road
Athens, GA 30603 Dahlonega, GA 30533 Hartwell, GA 30643
(706) 369-5620 (706) 864-1972 (706) 856-2670

Augusta Dalton Jefferson

3132 Wrightsboro Road, Suite A 710 South Hamilton Street 78 Washington Street
Augusta, GA 30909 Dalton, GA 30720 Jefferson, GA 30549
(706) 731-7062 (706) 272-2117 (706) 367-4759

Brunswick DeKalb Parole Center (Decatur, Jesup

1429 Union St. GA) 261 North Brunswick Street
Brunswick, GA 31521 4291-A Memorial Drive Jesup, GA 31545
(912) 264-7386 Decatur, GA 30032 (912) 427-5890
(404) 298-3656
Cairo Jonesboro
240 2nd Avenue, S.E. Douglas 7681 Southlake Pkwy.,
Cairo, GA 39828 14 Airport Circle Suite 710
(229) 377-9859 Douglas, GA 31533 Jonesboro, GA 30236
(912) 389-4048 (770) 473-2450
Canton
220 Brown Industrial Parkway, Ste. Douglasville LaFayette
100, Canton-Cherokee Industrial Park 8687 Hospital Drive Suite 103 901 North Main Street
Canton, GA 30114 Douglasville, GA 30134 LaFayette, GA 30728
(770) 720-3530 (770) 489-3029 (706) 638-5560

Carrollton Dublin
202 Tanner St. 125 West Jackson Street
Carrollton, GA 30117 Dublin, GA 31021
(770) 836-6894 (478) 275-6606

Clarkesville Eatonton
194 Professional Park 824 Oak Street Suite 1
Clarksville, GA 30523 Eatonton, GA 31024
(706) 754-6701 (706) 485-4554

Columbus Ellijay
114 Enterprise Court 26 River Terrace, Suite 201
Columbus, GA 31904 Ellijay, GA 30540
(706) 649-1105 (706) 276-7066
LaGrange Savannah
135 Buena Vista Drive 607 Abercorn St., Suite A
LaGrange, GA 30241 Savannah, GA 31401
(706) 845-4075 (912) 651-2003

Lawrenceville South Metro Parole Center

595 Old Norcross Road, Suite E 1568-A Willingham Drive
Lawrenceville, GA 30045 College Park, GA 30337
(770) 995-2189 (404) 559-6616

Lyons South Richmond (Augusta, GA)

135 S. W. Broad St. 3132 Wrightsboro Road, Suite A
Lyons, GA 30436 Augusta, GA 30909
(912) 526-4509 (706) 731-7062

Macon Statesboro
1552 Rocky Creek Road 51-55 East Main St
Macon, GA 31206 Statesboro, GA 30458
(478) 751-6218 (912) 681-5658

Marietta Thomaston
1220-F Kennestone Circle 113-C East County Road
Marietta, GA 30066 Thomaston, GA 30286
(770) 528-3724 (706) 646-6030

Milledgeville Thomasville
2271 Vinson Hwy., Arnall Bldg. 436-G Smith Avenue
Milledgeville, GA 31061 Thomasville, GA 31792
(478) 445-4431 (229) 225-4060

Monroe Thomson
226 Alcova Place, Suite E-17 108 Gordon Street
Monroe, GA 30655 Thomson, GA 30824
(770) 207-4160 (706) 595-5891

Moultrie Valdosta
117 First Ave., S. E. 120 North Oak Street
Moultrie, GA 31768 Valdosta, GA 31601
(229) 891-7260 (229) 333-5305

North Fulton (Atlanta, GA) Warner Robins

3201 Atlanta Ind. Pkwy., Suite 306 2505 Moody Road
Atlanta, GA 30331 Warner Robins, GA 31088
(404) 699-6835 (478) 329-4730

Rome Waycross
504 Riverside Pkwy., Suite 500 106 Albany Avenue
Rome, GA 30161 Waycross, GA 31501
(706) 295-6483 (912) 285-6323