St. Petersburg Police Public Safety Cadet Application

PUBLIC SAFETY CADETS UNIT #1969 Membership Application
1.1 - Name

First NameLast Name
1.2 - Today's Date
The St. Petersburg Police Public Safety Cadets Unit #1969 is a coeducational program chartered through the Public Safety Cadets organization and sponsored by the St. Petersburg Police Department. The unit has served the community since 1969. Public Safety Cadets are not sworn law enforcement officers and possess no police powers.

The program provides young people with education, training, leadership development, community service opportunities, and exposure to careers in law enforcement. An interest in a law enforcement career is encouraged but is not required for membership.
Eligibility Requirements
1. Pass a criminal background investigation. Any felony conviction and certain misdemeanor offenses may disqualify an applicant.
2. Be enrolled in school, have completed the eighth grade, and be at least 14 years old but younger than 19 at the time of acceptance. A member accepted before their 19th birthday may remain in the program until age 21.
3. Maintain a minimum 2.0 grade point average (GPA). Members participating on the pistol team or other special teams must maintain at least a 2.5 GPA.
4. Attend four consecutive regular meetings and successfully complete an oral interview conducted by an acceptance board consisting of ranking Public Safety Cadets and program Mentors.
5. Participate consistently in regular meetings, training, and special events. Active participation is essential to membership and successful completion of the program.
6. Submit the completed application no later than the second meeting.
IMPORTANT: Complete every applicable field. If a question does not apply, enter "N/A." Do not leave blank spaces.
Fees & Initial Uniform Information
After acceptance, a one-time registration fee of $40.00 is collected by cash or check. This fee covers program registration, secondary insurance when applicable, and initial supplies. An annual membership fee of $30.00 is due each October.

After acceptance and payment of dues, the new member will be issued a black polo shirt. New members should not purchase handcuffs, flashlights, or similar equipment. The only required personal purchases are black polishable shoes or boots, black socks, and black crew-neck T-shirts. Eligible members will be issued required equipment for the Class B uniform.

PARENT/GUARDIAN ACKNOWLEDGMENT
All information must be true, complete, and accurate. Information provided in this application may be checked and verified. Material discrepancies, intentional omissions, or falsification may result in immediate disqualification from membership consideration or dismissal from the program.

Questions regarding this application may be directed to:

Officer Vincent Calvino • (727) 892-5082 • PublicSafetyCadets@stpete.org
Applicant Acknowledgment
I am applying for membership in the St. Petersburg Police Public Safety Cadets Unit #1969. I have read the information and requirements in this application and certify that I meet the stated eligibility requirements. I agree to follow all program and department rules and policies. I understand that participation is voluntary and at will, and that the sponsoring agency, acting through the Public Safety Cadets program, may terminate membership in accordance with applicable program and department rules.
2.1 - Applicant Printed Name
Applicant Applicant Signature
Date Applicant Signed

MonthDayYear
2 digit month, 2 digit day, 4 digit year
Parent/Guardian Authorization
I/We, the undersigned parent or legal guardian of the applicant listed below, authorize the minor applicant to continue the Public Safety Cadet application process. I/We have read the information in this application and understand that a background investigation will be conducted. I/We authorize relevant findings to be considered by the acceptance board and program Mentors for membership purposes.
Applicant Name
2.2 - Parent/Guardian Printed Name
Signature
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit year

PUBLIC SAFETY CADET — BIOGRAPHICAL INFORMATION
All questions must be answered. If a question does not apply, enter "N/A."
3.1 - Applicant Name (Last, Suffix, First, Full Middle):

First NameMiddle NameLast NameSuffix
3.2 - Date of Birth

MonthDayYear
3.3 - Age
3.4 - Race
3.5 - Sex
3.6 - Weight (in lbs.)
3.7 - Height (in Ft and inches)
3.8 - Hair Color
3.9 - Eye Color
3.10 - Address

Street Address

Street Address Line 2

CityState

Zip Code
3.11 - Primary Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
3.12 - Applicant Email Address:
example@example.com
3.13 - Social Security Number (used only for background investigation):
3.14 - Driver's License or ID Number
3.15 - Driver's License Class
3.16 - Driver's License State
3.17 - Driver's License Expiration Date:

MonthDayYear
2 digit month, 2 digit day, 4 digit year
3.18 - List all scars, marks, tattoos, and piercings, including surgical scars, birthmarks, or other identifying marks. List "None" If you don't have any
3.19 - Current School:
3.20 - Current Grade:
3.21 - Expected High School Graduation Year:
3.22 - Currently Lives With (Parent/Guardian):
3.23 - Relationship:
3.24 - Public Safety Cadet Applicant Signature
3.25 - Date

MonthDayYear
2 digit month, 2 digit day, 4 digit year

PARENT/GUARDIAN & EMERGENCY CONTACT INFORMATION
All questions must be answered. If a question does not apply, enter "N/A."
4.1 - Parent/Guardian Name (Last, Suffix, First, Full Middle):

First NameMiddle NameLast NameSuffix
4.2 - Date of Birth

MonthDayYear
4.3 - Relationship to Applicant:
4.4 - Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
4.5 - Parent/Guardian Primary Phone Number:
Format: (000) 000-0000.
4.6 - Parent/Guardian Email Address:
example@example.com
4.7 - Parent/Guardian Employer Name:
4.8 - Parent/Guardian Employer Phone:
Format: (000) 000-0000.
4.9 - Do you have any Emergency Contacts other than Parent/Guardian
Emergency Contact 1— Other Than Parent/Guardian Listed Above
4.10 - Emergency Contact 1 Name

First NameMiddle NameLast NameSuffix
4.11 - Emergency Contact 1 Date of Birth:

MonthDayYear
4.12 - Emergency Contact 1 - Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
4.13 - Emergency Contact 1 Relationship to Applicant:
4.14 - Emergency Contact 1 Cell Phone:
Format: (000) 000-0000.
4.15 - Emergency Contact 1 Home Phone:
Format: (000) 000-0000.
4.16 - Emergency Contact 1 Work Phone:
Format: (000) 000-0000.
4.17 - Emergency Contact 1 Other Phone:
Format: (000) 000-0000.
Any Other person you would like to list as an emergency contact?
Emergency Contact 2
4.18 - Emergency Contact 2 Name

First NameMiddle NameLast NameSuffix
4.19 - Emergency Contact 2 Date of Birth:

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
4.20 - Emergency Contact 2 - Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
4.21 - Emergency Contact 2 Relationship to Applicant:
4.22 - Emergency Contact 2 Cell Phone:
Format: (000) 000-0000.
4.23 - Emergency Contact 2 Home Phone:
Format: (000) 000-0000.
4.24 - Emergency Contact 2 Work Phone:
Format: (000) 000-0000.
4.25 - Emergency Contact 2 Other Phone:
Format: (000) 000-0000.
By signing below, I certify that the applicant information and parent/guardian information provided are true and correct.
4.26 - Parent/Guardian Signature
4.27 - Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate

6.1 - Have you ever been employed?
Employment History
6.2 - Current Employer
6.3 - Was there a previous employer before your current employer?
6.3 - Previous Employer 1
6.4 - Was there any other previous employers?
6.4 - Previous Employer 2
Applicant Certification
I certify that all statements made in connection with this application, including information regarding my background, training, and experience, are true and complete to the best of my knowledge. I understand that any material misstatement, intentional omission, or falsification may result in disqualification from appointment or removal from the St. Petersburg Police Public Safety Cadets program.
6.5 - Applicant Employment Certification Signature
6.6 - Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
6.7 -Parent/Guardian Employment Certification Signature
6.8 - Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate

PREVIOUS LAW ENFORCEMENT CONTACT
(To be completed by the applicant)
List every contact you have had with any law enforcement agency, court, police department, sheriff's office, or other justice agency. This includes, but is not limited to, traffic crashes, traffic stops, citations, warnings, being a witness to a crime, juvenile matters, arrests, detentions, or any other law enforcement contact. Include the approximate date or time frame, the agency involved, the nature of the incident, and the action taken.
Intentional falsification or omission of information may result in automatic rejection from membership consideration.
7.1 - Have you had any contact with law enforcement?
7.2 - Law Enforcement Contact 1
7.3 - Contact 1 - Nature of Contact and Action Taken
7.4 - Have you had any other contact with law enforcement?
7.5 - Law Enforcement Contact 2
7.6 - Contact 2 - Nature of Contact and Action Taken
7.7 - Have you had any other contact with law enforcement?
7.8 - Law Enforcement Contact 3
7.9 - Contact 3 - Nature of Contact and Action Taken
7.10 - Have you had any other contact with law enforcement?
7.11 - Law Enforcement Contact 4
7.12 - Contact 4 - Nature of Contact and Action Taken
7.13 - Applicant Signature
7.14 - Date

MonthDayYear
2 digit month, 2 digit day, 4 digit year
7.15 - Parent/Guardian Signature
7.16 - Date

MonthDayYear
2 digit month, 2 digit day, 4 digit year

PARTICIPANT / MODEL / ARTIST / PERFORMER RELEASE
I authorize the City of St. Petersburg, the St. Petersburg Police Department, WSPF-TV Channel 35/15, the Public Safety Cadets, the Florida Association of Police Explorers, and their authorized agents to use my name, likeness, appearance, video image, or photograph for lawful advertising, educational, public-information, trade, or promotional purposes.

I understand that any production, proof, print, photograph, recording, or video created for these purposes may remain the property of the City of St. Petersburg and its authorized agents. I certify that this release does not violate any existing contract or commitment for which I am responsible.

I further agree that if I receive copies of photographs, recordings, or other media created for City advertising, trade, educational, public-information, or promotional purposes, I will not authorize their use by another party without approval from an authorized representative of the City of St. Petersburg.
8-1. I choose to participate in photo/video/media activities covered by this release
8-2. Is the participant age 18 or older?
8.3 - Participant Printed Name
8.4 - Date

MonthDayYear
2 digit month, 2 digit day, 4 digit year
8.5 - Participant Signature
8.6 - Parent/Guardian Printed Name
8.7 - Date

MonthDayYear
2 digit month, 2 digit day, 4 digit year
8.8 - Parent/Guardian Signature

UNIFORM & EQUIPMENT AGREEMENT
Upon leaving Unit #1969 for any reason, the member must immediately return all assigned brass, uniforms, shirts, pants, equipment, identification items, and any other property belonging to the St. Petersburg Police Public Safety Cadets or the St. Petersburg Police Department. The member may be responsible for the replacement cost of lost, damaged beyond normal wear, or unreturned property, as permitted by applicable policy.

By signing below, the member acknowledges responsibility for safeguarding issued property and returning all program or department property promptly upon request or separation.
9.1 - I understand and acknowledge my responsibility for safeguarding issued property and returning all program or department property promptly upon request or separation.
9.2 - Is the participant age 18 or older?
9.3 - Public Safety Cadet Printed Name
9.4 - Date

MonthDayYear
2 digit month, 2 digit day, 4 digit year
9.5 - Public Safety Cadet Participant Signature
9.6 - Parent/Guardian Printed Name
9.7 - Date

MonthDayYear
2 digit month, 2 digit day, 4 digit year
9.8 - Parent/Guardian Participant Signature
Should be Empty:

PUBLIC SAFETY CADETS UNIT #1969 Membership Application

IMPORTANT: Complete every applicable field. If a question does not apply, enter "N/A." Do not leave blank spaces.

PARENT/GUARDIAN ACKNOWLEDGMENT

PUBLIC SAFETY CADET — BIOGRAPHICAL INFORMATION

PARENT/GUARDIAN & EMERGENCY CONTACT INFORMATION

Emergency Contact 1— Other Than Parent/Guardian Listed Above

Emergency Contact 2

APPLICANT BACKGROUND & PARTICIPATION QUESTIONS

Employment History

PREVIOUS LAW ENFORCEMENT CONTACT

PARTICIPANT / MODEL / ARTIST / PERFORMER RELEASE

UNIFORM & EQUIPMENT AGREEMENT