Volunteer Application Form

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Please correct the field(s) marked in red below:

Tennessen Warning, Minn.Stat.13.04, Subd. 2

The information requested on this form will be used for consideration of your participation in Moorhead Police Department’s Police Volunteer program.  Its intended use is to assist Moorhead Police Department (MPD) personnel to conduct a background check to verify eligibility of participating as a Police Volunteer.  You are not legally obligated to supply the data.  However, failure to do so could result in this department’s inability to conduct a background check which is required to verify eligibility to become a Police Volunteer.  Persons authorized to access information include MPD personnel. 


Basic Information
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Name:
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Address:
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City:
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State:
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Zip:
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Phone:
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Email:
Educational Background
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High School Attended:
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Graduated:
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Date of graduation:
College or Technical Training:
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School
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Date Attended
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Degree
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School
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Date Attended
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Degree
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Other Education or Training
Employment History
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Current or Most Recent Employer:
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Address:
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Dates Employed:
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Your Supervisor's Name:
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-Phone:
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-May We Contact?
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Position and Primary Duties:
Other organizations where you have worked or volunteered in the past ten years:
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Organization:
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-Dates:
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-Supervisor:
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-Position and Duties:
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Organization:
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-Dates:
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-Supervisor:
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-Position and Duties:
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Organization:
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-Dates:
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-Supervisor:
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-Position and Duties:
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What is your present employment status?
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Have you ever been discharged or asked to resign by any employer?
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If Yes, please explain:
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Have you ever pleaded guilty, or been convicted of a felony or misdemeanor?
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If Yes, please explain:
Special Skills and Abilities
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Please identify and special skills, training and abilities you feel may be useful to the Moorhead Police Department:
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Do you speak Spanish or any other languages?
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If yes, please specify:
Availability and Time Commitment
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Regular schedule: How many hours per week?
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per month?
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Do you have a current MN driver's license?
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Please state briefly why you would like to be part of the Moorhead Police Volunteer Program:
Activities and Interests
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The following are activities/projects MPD volunteers frequently perform.  Please indicate those that you feel you could perform and/or are interested in learning:
Software/Technology I am Familiar with
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The following are activities/projects MPD volunteers frequently perform.  Please indicate those that you feel you could perform and/or are interested in learning:
References
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Please provide the names, addresses and phone numbers of three non-relative references of people who know you well, and that you give us permission to contact:
Person to contact in the event of an emergency:
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Name:
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Phone:
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By checking this box, I am certifying that all information contained in this application is true and complete to the best of my knowledge and belief. I further understand that acceptance into the Moorhead Police Volunteers is contingent upon investigation of my previous employment record and references, without further notification to me. I also give the MPD permission to conduct a criminal investigation of my background.
 *
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Date:

Background Investigation

As an applicant for a volunteer position with the Moorhead Police Department, you are being asked to provide information about yourself which will be used to evaluate your suitability for this type of position.

You are not legally required to provide the requested information. However, if you do not, the Moorhead Police Department will be unable to conduct the required background inquiries and will not be able to process your application and the City of Moorhead will not be able to consider you for a volunteer position.

Your Full Name:

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First Name
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Middle Name:
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Last Name:
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Other names you have been known to use:
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Your current address:
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Other states in which you have resided:
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Birth Date:
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I hereby authorize the City of Moorhead to use this information to determine my suitability as a MPD volunteer
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Confidentiality Agreement
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I recognize that, if I am accepted into the Moorhead Police Department Volunteer Program, I will, at times, be in a position to read or come into contact with confidential, private and sensitive information in the course of my volunteer duties
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I understand that this information cannot be copied, removed from the Law Enforcement Center, or shared with anyone other then Moorhead Police Department employees.
 *
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I understand that a violation of this confidentiality agreement will mean termination of my Moorhead Police Volunteer status.
 *
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