GLASSBORO POLICE EXPLORER POST # 7120

GLASSBORO POLICE EXPLORER

POST #7120
Glassboro Police Explorers Post # 7120

1 South Main Street * Glassboro, NJ 08028 (856) 881-1501

The Glassboro Police Department sponsors a Police Explorer Program for young adults ages 14 through 20 years old who are interested in Law Enforcement as a possible career. We are looking for new members of good moral character and a positive attitude.

The program includes a two-hour instruction period with active participation approximately one or two nights a month from 6:30 p.m. to 8:30 p.m. Instruction is related to police procedures, law, traffic control and related subjects. Eventually, members are permitted to perform some limited police related duties at special events. A ride-along program is also available to Explorers who are at least 16 (sixteen) years of age, have completed a minimum of 9 (nine) months prior service with the Post, have attended 75% of all post functions, successfully passed a written test and all ride-along preparatory training.

If you are interested in becoming a Glassboro Police Explorer or would like more information about the Program, please contact:

Patrolman Tim Cain #9144 Glassboro Police Department tcain@glassboropd.org
HOLD HARMLESS AGREEMENT
The undersigned, parents or guardians of
Name of Explorer
member of the Glassboro Police Explorer Post #7120, hereby indemnifies and holds harmless the Borough of Glassboro, its agencies and employees, specifically including any and all Police Officers or personnel involved with the supervision and control of the Glassboro Police Explorer Post # 7120, from any claims of any kind whatsoever or of any
nature for injury to the person or damage to the property of
Name of Explorer
his/her parents, siblings or heirs. This indemnity and hold harmless agreement shall be considered a complete and total waiver of any and all liability on the part of the Borough of Glassboro, its servants, agents, or employees and particularly the Police Officers engaged in the supervision and control as set forth hereinabove.
Parent / Guardian
Date

MonthDayYear
Date
ADULT EXPLORER

This section is if the Explorer is 18 years or older and is to be signed by the Explorer
HOLD HARMLESS AGREEMENT
The undersigned, a member of the
Name of Explorer
Glassboro Police Explorer Post #7120, hereby indemnifies and holds harmless the Borough of Glassboro, its agencies and employees, specifically including any and all Police Officers or personnel involved with the supervision and control of the Glassboro Police Explorer Post # 7120, from any claims of any kind whatsoever or of any nature for injury
to the person or damage to the property of
Name of Explorer
siblings or heirs. This indemnity and hold harmless agreement shall be considered a complete and total waiver of any and all liability on the part of the Borough of Glassboro, its servants, agents, or employees and particularly the Police Officers engaged in the supervision and control as set forth hereinabove.
Explorer Signature if over 18 y/o
Date

MonthDayYear
Date
APPLICATION AND PERSONAL HISTORY
Home/Cell Phone
Format: (000) 000-0000.
Home/Cell Phone
Format: (000) 000-0000.
Address
Birth Date

MonthDayYear
Date
Age
SS # (optional)
Height
Weight
Hair Color
Eye Color
Scars
Handicaps
Driver’s License Number
Do you own/operate a vehicle? Y/N Plate Number
Year/make/model of vehicle
What school attending
Year Graduating
Year Graduating
Employer
Address of Employer
Phone Number of Employer
Format: (000) 000-0000.
Hours per Week
Position held at work
Name of Supervisor
Mother’s Name
Address of Mother (if different from yours)
Mother’s Contact Number(s)
Father’s Name
Address of Father (if different from yours)
Address of Father (if different from yours)
Father’s Contact Number(s)
Previous Address(es) if lived at current address less than 3 years
Have you ever been arrested? Y/N If so, what were the circumstances?
Please list 2 names, addresses and phone numbers of persons we may contact for a background check (They must be 18 years old and not a family member)
Name #1

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Format: (000) 000-0000.
Name #2

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
I CERTIFY THAT ALL OF THE FOREGOING IS TRUE

Clear
Glassboro Police Department
1 South Main Street Glassboro, NJ 08028
Photo Release Form
Permission to Use Photographs and Video
I grant the Glassboro Police Department, its representatives and employees, the right to take photographs and / or video of me and/or my child. I authorize the Glassboro Police Department, its assigns and transferees to copyright and use and publish the same in print and/or electronically.

I agree that the Glassboro Police Department may use such photographs and/or video of me and/or my child for any lawful purpose, including for such purposes as publicity, illustration, advertising, and web content.

I have read and understand the above:
Parent / Guardian Printed Name
Child’s Printed Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent / Guardian Signature

Clear
Date

MonthDayYear
Date
Should be Empty:

GLASSBORO POLICE EXPLORER

HOLD HARMLESS AGREEMENT

ADULT EXPLORER

HOLD HARMLESS AGREEMENT

APPLICATION AND PERSONAL HISTORY

Glassboro Police Department

Photo Release Form

Permission to Use Photographs and Video