VIPS Application

		CLAYTON POLICE DEPARTMENT VOLUNTEER APPLICATION
Return to: Phone: Fax:	Clayton Police Department 6000 Heritage Trail Clayton, CA 94517 (925) 673-7350 (925) 672-1429	The City of Clayton is an Equal Opportunity Employer and hires on the basis of qualifications (training and experience), and ability to perform effectively int eh specified position. We do not and will not discriminate on the basis of race, color, religion, gender, etc., nor for disabilities that can reasonably be accommodated.
NAME ___________________________________________________________________________________________
ADDRESS ________________________________________________________________________________________
CITY STATE ZIP __________________________________________________________________________________
PHONE: HOME __________________________ WORK ___________________________ CELL _________________
EMAIL _____________________________________ DRIVER'S LICENSE/STATE ____________________________

Where did you hear about Clayton Police Department's volunteer opportunities: ___________________________________ __________________________________________________________________________________________________
EXPERIENCE
Describe fully any job related skills, knowledge, special training, certificates, registrations or licenses you may possess or machines/equipment that you can operate which might apply to volunteer assignments: _____________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________
Other languages spoken: ______________________________________________________________________________
Computer programs you can use: _______________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________
Please list any information about yourself such as hobbies and interests: _________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________
EXPERIENCE
Please describe any work experience, volunteer work, or other life experiences which would apply to a volunteer assignment at the Police Department: _____________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________
LIMITATIONS
Are there any physical conditions we whould consider in arranging volunteer assignments for you? ____________________ If "yes", please explain: _______________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ When are you able to volunteer? Time of Day/Day of Week/Amount of Time: ____________________________________ __________________________________________________________________________________________________
EMERGENCY CONTACT
NAME __________________________________________________________RELATIONSHIP ___________________ ADDRESS _________________________________________________________________________________________ CITY/STATE/ZIP ___________________________________________________________________________________ HOME PHONE _______________________________________ WORK PHONE _______________________________ CELL PHONE ________________________________________ OTHER ______________________________________
CERTIFICATE OF APPLICANT
I certify that the information shown is true, complete and correct to the best of my knowledge, and that misstatements may subject me to disqualification or dismissal. I further understand any or all information included on this application is subject to verification by the City of Clayton. Signature _____________________________________________________ Date _________________________________

CLAYTON POLICE DEPARTMENT VOLUNTEER APPLICATION

CLAYTON POLICE DEPARTMENT
VOLUNTEER APPLICATION