Dallas Police Department Volunteer Application   PERSONAL Name (Last, First, Middle)  Race / Sex   Date of Birth ____________________________________________________________________ Street Address       Home Phone ____________________________________________________________________ City, State, Zip     Texas D.L. or ID Number ____________________________________________________________________ Social Security Number    Business Phone ____________________________________________________________________ Do you live in Dallas ?  How Long? Do you work in Dallas?  How Long? ____________________________________________________________________ EDUCATION High School Graduate  GED  Name and Address of High School ____________________________________________________________________ College Graduate Degree & Major  Name and Address of College ____________________________________________________________________ BACKGROUND Please explain, briefly, why you wish to be a volunteer for the Dallas Police Department ____________________________________________________________________ Are there any skills would you like to utilize while volunteering? ____________________________________________________________________ What Volunteer Program (COPS, VIP, CHIPS, VRT) are you interested in? VIP-Neighborhood Association: Have you had any moving violations in the last two years? (Volunteer Response Team only) If yes, explain (date, cited for) ____________________________________________________________________ Have you ever been arrested for, convicted of, or cited for an offense other than traffic violations? ____ yes ____ no. If yes, on a separate sheet of paper explain in detail showing dates, charges, places, and actions taken. ____________________________________________________________________ EMPLOYMENT Present Employer  Supervisor   Your Title ____________________________________________________________________ Address   Phone    Date Hired ____________________________________________________________________ Previous Employer  Supervisor   Your Title ____________________________________________________________________ Address   Phone    Date Hired ____________________________________________________________________ EMERGENCY CONTACT Name    Relationship ____________________________________________________________________ Address   Home Phone   Work Phone ____________________________________________________________________ MEDICAL HISTORY Medical information is needed in the event of an emergency. List any medications you are currently taking and the reason for which they are used, and any other medical information you feel the Dallas Police Department should know. Attach a separate sheet, if necessary. ____________________________________________________________________ CERTIFICATION and SIGNATURE Please review you answers carefully and read the statements below before signing this application. I hereby certify that there are no willful misrepresentations, omissions, or falsifications in the foregoing statements and answers to questions. I understand that any omission or false statement on this application shall be sufficient cause for rejection for enrollment or dismissal from the Dallas Police Department Volunteer Program. I understand the purpose of the Volunteer Program is not to train citizens to be police officers and that all Volunteer Programs are non-confrontational. I acknowledge that through my volunteer service I may be privileged to information that is not available to the public and any release of that information may result in civil as well as criminal proceedings. I will abide by all rules and regulations set forth by the Dallas Police Department. I give the Dallas Police Department and its agents permission to conduct a thorough background investigation that may include, but not be limited to, fingerprinting, any criminal history, employment history, and personal references.   Applicant`s Signature: ____________________ Date: _________________________ Mail to: VIP Coordinator/Ron Carpenter NE Dallas Police Dept. 9915 E. NW Hwy. Dallas, TX. 75238