FPD Volunteer Application Form

2. Name*
   Last, First, Middle
3. Date of Birth*
5. Address1*
7. City*
8. State*
9. Zip*
11. Home Phone*
12. Mobile*
13. Email
15. Are you a United States citizen? *

    1. Yes

    1. No
16. If not, what country are you a citizen of?
18. Education Level (Select last level of school completed)*

    1. 8
    2. 9
    3. 10

    1. 11
    2. 12
    3. 13

    1. 14
    2. 15
    3. 16

    1. 17
    2. 18
20. Education (Check all that apply)*

    1. High School Diploma
    2. GED
    3. Associate's Degree
    4. Bachelor's Degree
    5. Master's Degree
    6. Doctorate Degree
21. College Attended
22. Major/Minor
24. Current Occupation*
25. Years/Months with Employer*
27. Name & Address of Employer*
29. Employer Supervisor & Phone #*
31. Previous Work Experience (To include prior volunteer work):
33. Employer*
34. Position*
35. Duties*
36. From / To (Month & Year)*
38. Employer
39. Position
40. Duties
41. From / To (Month & Year)
43. Employer
44. Position
45. Duties
46. From / To (Month & Year)
48. Employer
49. Position
50. Duties
51. From / To (Month & Year)
53. Employer
54. Position
55. Duties
56. From / To (Month & Year)
58. Employer
59. Position
60. Duties
61. From / To (Month & Year)
63. Employer
64. Position
65. Duties
66. From / To (Month & Year)
68. Do you currently, or have you previously, served in any branch of the United States Armed Forces?*

    1. Yes

    1. No
69. If so, which branch?
70. Were you honorably discharged?

    1. Yes
    2. No
72. Do you have a valid driver's license?*

    1. Yes

    1. No
73. If so, what state?*
75. Have you received any traffic or criminal citations in the last ten years?*

    1. Yes

    1. No
77. If so, list all offenses, dates, locations, agencies of issuance and dispositions of each below:*
79. Have you ever been arrested and/or convicted of a misdemeanor or felony crime?*

    1. Yes

    1. No
81. If so, list all offenses, dates, locations, agencies of issuance and dispositions of each below:*
83. Do you use, have you used, or experimented with any illegal drugs, to include marijuana, in the last three years?*

    1. Yes

    1. No
85. If so, provide circumstances, specific dates, illegal drug, and number of times used:*
87. Please provide a short paragraph stating your reasons for wanting to participate in the Farmington Police Department's Volunteer Program:*
89. What do you hope to gain from this experience (Be specific with your response)?*
91. Please list your current and/or prior community affiliations (churches, clubs, organizations, etc):*
93. What is a realistic number of hours you would be willing to commit to on a quarterly basis?*
95. What special skills, training, or certifications do you possess?*
97. What type of hobbies or recreational activities do you regularly participate in?*
99. How would you describe your current level of fitness (check one)?*

    1. Not Fit
    2. Mildly Fit
    3. Moderately Fit
    4. Highly Fit
    5. Exceedingly Fit
101. Are you a graduate of the Farmington Police Department Citizens Academy?*

     1. Yes

     1. No
102. If yes, Class # and Year:*
104. If not, are you interested in attending a future Citizens Academy?

     1. Yes

     1. No

     1. Maybe
106. References (Do not include relatives):
108. Name*
109. Association*
111. Address (street, city, state, zip)*
112. Phone #*
113. Years Known*
115. Name*
116. Association*
118. Address (street, city, state, zip)*
119. Phone #*
120. Years Known*
122. Name*
123. Association*
125. Address (street, city, state, zip)*
126. Phone #*
127. Years Known*
129. It is standard procedure as part of the Farmington Police Department's Volunteer Program to submit each applicant to a minimal background check. The suitability of new volunteers is of great importance due to the nature of the volunteer work and connection as a representative of the Farmington Police Department. Successful completion of volunteer training sessions is also a mandatory ingredient for continued participation in the program. It is vital as a representative of the Farmington Police Department and the City of Farmington that one must hold him or herself to a much higher standard as a volunteer. Therefore, adherence to the department's established policies, procedures, and ethical code is of the utmost importance at all times, if successful in the application process. Any member of the community, 19 years of age or older and has not been convicted of a felony or misdemeanor crime (certain misdemeanors may be waived), who has a genuine concern for the quality of life within the Farmington community, is welcome and encouraged to submit a Farmington Police Department Volunteer Program application. This process may entail an interview panel.
131. Applicant's Signature*
     By providing an electronic signature, I am stating that the information provided is true and correct.
132. Date*
Leave This Blank:


134. 1. Receive an email copy of this form.
135. Email address

     This field is not part of the form submission.

136. Submit

* indicates a required field