San Jose Police Department - Ride Along Form -v3

San Jose Police Department - Ride Along Form

++++ Form Open Section ++++
MUST BE 18 YEARS OR OLDER TO PARTICIPATE
Contact Information
Full Name*

First NameMiddle NameLast Name
AKA's

First NameMiddle NameLast Name
Other Names

First NameMiddle NameLast Name
Date

MonthDayYearHourMinutes
Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
DOB*

MonthDayYear
Gender*

MaleFemaleNon-Binary
Preferred Day of Week for the Ride Along

SundayMondayTuesdayWednesdayThursdayFridaySaturday
Preference: Day or Night

Daytime Ride AlongNightime Ride Along
Scars, Marks, Tatoos
Last 4 SS No.*
Driver's License*
License State*
E-mail*
Alt. Phone
Cell Phone
Recruit*

NoYes
Check "Yes" only if you are currently a recruit applicant seeking employment
with the San Jose Police Department.
Accept*

By clicking the submit button I agree to the privacy agreement.
PRIVACY AGREEMENT
Please be advised that any information you enter in the City of San José’s, Police Department ride along form or job application will be retained by the City of San José as soon as you save that information. Please note that the City of San José holds all confidential information in the strictest of confidence and does not disclose or provide access to confidential information to unauthorized persons, unless required by law. The privacy of our applicants is very important to us. We take precautions to protect your personal information by using a variety of security measures to reduce the risk of loss, misuse, unauthorized access, disclosure or modification of your information.
Requestor:

Division:
Reserve Unit

Unit:
VOLT Volunteer Program

Phone:
(408) 277-8658

Purpose:
Citizen Ride-Along Program
Should be Empty: