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Application for internship, practicum or field experience with Johnson County Mental Health Center

Please complete this application for an internship, practicum or field experience. It is the policy of Johnson County Government not to discriminate against any individual because of race, color, sex, religion or creed, age disability, pregnancy, ancestry or national origin, military status or membership or service in the military. In addition, the county prohibits discrimination on the basis of political affiliation or belief. 

Files must be less than 2 MB.
Allowed file types: pdf doc docx.
If selected for Field Experience, I understand I must conform to the policies of Johnson County Government and to any departmental/agency rules and regulations. I hereby certify the information given on all pages of this application packet is true and correct. I understand any answers contrary to the truth may be grounds for dismissal or refusal to select for placement and nothing has been withheld which would affect my Field Experience. I authorize my former employers, educational institutions and other persons or entities identified in this application to provide any and all information or documents about me to Johnson County, Kansas. I hereby relieve all individuals connected with such release from liability for providing this information.