LLPD Volunteer Application

Lacy Lakeview Police Department Volunteer Application Form
Full Name
Date of Birth

MonthDayYear
Date
Home Address
City State ZIP
Phone Number
Format: (000) 000-0000.
Email Address
example@example.com
Drivers License Number if applicable
State Issued
Expiration Date

MonthDayYear
Date
Preferred Start Date

MonthDayYear
Date
Days Available (check all that apply): [] Monday [] Tuesday [ ] Wednesday Thursday Friday
Times Available
How many hours per week are you available
Name
Relationship
Phone Number
Format: (000) 000-0000.
Have you volunteered before If so where and what did you do
Please describe any skills training or certifications relevant to this position
Legal and Background Information Have you ever been convicted of a criminal offense? Yes[]No If yes, please explain:
If yes please explain
Are you currently employed? [] Yes []No
Employer Name
I certify that the information provided is true and complete to the best of my knowledge. I understand that providing false information may result in disqualification from the
Signature
Date

MonthDayYear
Date
ParentGuardian Signature if under 18
Date

MonthDayYear
Date
Should be Empty: