601 E. Trade Street Charlotte, NC 28202
Full Name
Volunteer Age Group
For volunteers of the ages of 16 and 17, please fill out the Parental Consent Form to have your application properly processed.
Please check each box as you read them. I...
Enter name again to confirm you have read and check marked all of the sentences above honestly.
In order to be considered as a volunteer, I understand the following items will be required for the application process: Driver's License, DMV Check, Police Record Check, Drug screening to be completed within 48 hours and a Confidentiality Statement. I state that all the information I have given is correct to the best of my knowledge. I understand that my volunteer position may be terminated without my permission.
PERSONAL INQUIRY WAIVER: I authorize the Charlotte-Mecklenburg Police Department to examine all records that are necessary to determine my character, reputation, arrest record, and criminal history. All information not otherwise a public record will remain confidential, and will be utilized solely for the evaluation of my qualifications and fitness to be assigned with the Charlotte-Mecklenburg Police Department in a volunteer capacity.
Enter name to acknowledge the personal inquiry waiver.
Enter today's date
Residential Address
Enter mailing address if different from residential
Date of birth
Race
Degree(s) Check all that apply
The questions contained in this section are utilized solely for background investigation purposes, and will remain strictly confidential.
How often do you drink?
Have you ever tried, used, or experimented with Marijuana?
Have you tried, used, or experimented with heroin?
Have you ever tried, used, or experimented with cocaine?
Have you ever tried, used, or experimented with any other illegal substance?
Have you ever tried, used or experimented with any other controlled substance that was not prescribed by a physician?
Have you ever tried, used or experimented with a prescription medication that was not prescribed for you?
Have you ever tried or used a prescription medication, prescribed for you, when it was not medically necessary?
Have you ever served in the armed forces?
Employeers business address
Contact person at business
List two personal references who have known you for at least five (5) years. Do not include relatives.
Reference Contact 1
Reference Contact 2
Have you ever (as an adult or a juvenile) been arrested, detained, or questioned by the police concerning a crime?
Upload File(s)
Have your driving privileges ever been suspended, revoked, or cancelled?
Have you ever received (a) traffic citation(s)?
Have you ever committed a serious crime for which you were not arrested?
By entering my name in the boxes below, I affirm that this application contains no false statements, misrepresentations, or omissions; nor did I intentionally conceal any material that would knowingly make me ineligible. I further understand that at any time during my background investigation, should any information be discovered in this application which is not factual, I will become ineligible for any volunteer position with the Charlotte-Mecklenburg Police Department.
Today's Date
Volunteer Name
Volunteer Address
Emergency Contact 1
Emergency Contact 2
Emergency Contact 3
Results of Test
Results of Polygraph
