Volunteer Application Form

Tennessen Warning, Minn.Stat.13.04, Subd. 2

The information requested on this form will be used for consideration of your participation in Moorhead Police Department’s Police Volunteer program.  Its intended use is to assist Moorhead Police Department (MPD) personnel to conduct a background check to verify eligibility of participating as a Police Volunteer.  You are not legally obligated to supply the data.  However, failure to do so could result in this department’s inability to conduct a background check which is required to verify eligibility to become a Police Volunteer.  Persons authorized to access information include MPD personnel. 

Basic Information

1

Name:

Name

2

Address:

Address

3

City:

City

4

State:

State(Select State) Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

5

Zip:

Zip

6

Phone:

Phoneext.

7

Email:

Email

Educational Background

8

High School Attended:

High School Attended

9

Graduated:

Yes

No

10

Date of graduation:

Date of graduation

College or Technical Training:

11

School

School

12

Date Attended

Date Attended

13

Degree

Degree

14

School

School

15

Date Attended

Date Attended

16

Degree

Degree

17

Other Education or Training

Other Education or Training

Employment History

18

Current or Most Recent Employer:

Current or Most Recent Employer

19

Address:

Address

20

Dates Employed:

Dates Employed

21

Your Supervisor's Name:

Your Supervisor's Name

22

Phone:

Phoneext.

23

May We Contact?

Yes

No

24

Position and Primary Duties:

Position and Primary Duties

Other organizations where you have worked or volunteered in the past ten years:

25

Organization:

Organization

26

Dates:

Dates

27

Supervisor:

Supervisor

28

Position and Duties:

Position and Duties

29

Organization:

Organization

30

Dates:

Dates

31

Supervisor:

Supervisor

32

Position and Duties:

Position and Duties

33

Organization:

Organization

34

Dates:

Dates

35

Supervisor:

Supervisor

36

Position and Duties:

Position and Duties

37

What is your present employment status?

Currently Employed

Not Employed

Retired

38

Have you ever been discharged or asked to resign by any employer?

No

Yes

39

If Yes, please explain:

If Yes, please explain

40

Have you ever pleaded guilty, or been convicted of a felony or misdemeanor?

No

Yes

41

If Yes, please explain:

If Yes, please explain

Special Skills and Abilities

42

Please identify any special skills, training and abilities you feel may be useful to the Moorhead Police Department:

Please identify any special skills, training and abilities you feel may be useful to the Moorhead Police Department

43

Do you speak Spanish or any other languages?

No

Yes

44

If yes, please specify:

If Yes, please explain

Availability and Time Commitment

45

Regular schedule: How many hours per week?

Regular schedule: How many hours per week?

46

Per month?

Per month?

47

Do you have a current MN driver's license?

Yes

No

48

Please state briefly why you would like to be part of the Moorhead Police Volunteer Program:

Please state briefly why you would like to be part of the Moorhead Police Volunteer Program

Activities and Interests

49

The following are activities/projects MPD volunteers frequently perform.  Please indicate those that you feel you could perform and/or are interested in learning:

Computer/Data Entry	Helping with traffic monitoring/control
Parking ticket patrol	Telephone calls to people with warrants
Internet research	Volunteer program recordkeeping
Weed/Snow removal enforcement	Internet research

Software/Technology I am Familiar with

50

The following are activities/projects MPD volunteers frequently perform.  Please indicate those that you feel you could perform and/or are interested in learning:

Microsoft Word	E-mail
Copy machine	Microsoft Excel
DVD player	Video Recorder
Other:

References

51

Please provide the names, addresses and phone numbers of three non-relative references of people who know you well, and that you give us permission to contact:

Please provide the names, addresses and phone numbers of three non-relative references of people who know you well, and that you give us permission to contact

Person to contact in the event of an emergency:

52

Name:

Name

53

Phone:

Phoneext.

54

By checking this box, I am certifying that all information contained in this application is true and complete to the best of my knowledge and belief. I further understand that acceptance into the Moorhead Police Volunteers is contingent upon investigation of my previous employment record and references, without further notification to me. I also give the MPD permission to conduct a criminal investigation of my background.

 *

55

Date:

Background Investigation

As an applicant for a volunteer position with the Moorhead Police Department, you are being asked to provide information about yourself which will be used to evaluate your suitability for this type of position.

You are not legally required to provide the requested information. However, if you do not, the Moorhead Police Department will be unable to conduct the required background inquiries and will not be able to process your application and the City of Moorhead will not be able to consider you for a volunteer position.

Your Full Name:

56

First Name

First Name

57

Middle Name:

Middle Name

58

Last Name:

Last Name

59

Other names you have been known to use:

Other names you have been known to use

60

Your current address:

Your current address

61

Other states in which you have resided:

Other states in which you have resided

62

Birth Date:

Birth Date

63

I hereby authorize the City of Moorhead to use this information to determine my suitability as a MPD volunteer

 *

Confidentiality Agreement

64

I recognize that, if I am accepted into the Moorhead Police Department Volunteer Program, I will, at times, be in a position to read or come into contact with confidential, private and sensitive information in the course of my volunteer duties

 *

65

I understand that this information cannot be copied, removed from the Law Enforcement Center, or shared with anyone other then Moorhead Police Department employees.

 *

66

I understand that a violation of this confidentiality agreement will mean termination of my Moorhead Police Volunteer status.

 *

1. To receive a copy of your submission, please fill out your email address below and submit.
2. Email Address

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