Section 1 of 1 in this document

CMPD Volunteer Unit Application

Applicant Information

Title of Respect

Mr.

Ms.

other

Other title of respect

Full Name of Applicant

Nicknames

Applicant Address

Address: City

Address: Zip Code

Years at this residence

Is Mailing Address different from Residing Address?

Yes

Mailing Address

Mailing Address: City

Mailing Address: Zip Code

Contact Email Address

Contact Cell Phone Number

Contact Home Phone Number

Contact Work Phone Number

Date of Birth

Place of Birth: City

Place of Birth: State

Social Security Number

Driver's License Number

State Driver's License Issued

Sex

Male

Female

Race

White

Black

Hispanic

other

Race: Other

Height

Weight

Eye Color

Hair Color

Household Background

List of People Residing in your Household

Educational Background

Highest Level of Education

High School

College

Name of High School, City and State

Years of High School Completed

Name of College, City and State

Years of College Completed

Degree Earned

Associate

BA / BS

MA / MS

PhD

Major

Graduate Studies: Name of School, City and State

Years of Graduate Studies Completed

Additional Major

Additional Studies: Name of School, City and State

Years of Additional Studies Completed

Volunteer History

List any Prior Volunteer Experience

What is your primary reason for volunteering with us?

Health Screening History

How frequently do you consume alcoholic beverages?

Daily

Weekly

Monthy

Never

Special Occasions

Which alcoholic beverages are used and how many do you consume?

Have you ever tried, used or experimented with marijuana?

Yes

If yes to marijuana, how many times and what was the last date used?

Have you ever tried, used, or experimented with heroin?

Yes

Have you ever tried, used, or experimented with cocaine?

Yes

Have you ever tried, used, or experimented with any other illegal substance?

Yes

If yes to illegal substances, please provide the name of the substance

Have you ever tried, used, or experimented with any other controlled substance that was not prescribed by a physician?

Yes

Have you ever tried or used a prescription medication prescribed for you when it was not medically necessary?

Yes

Military History

Have you ever served in the armed forces?

Yes

Enlistment start date

Enlistment end date

Branch of military and Rank

Type of Discharge

References

Most Recent Employer

Name of Business

Street Address of Business

City / State / Zip Code of Business

Business Contact Name and Phone Number

Personal References

List three personal references who have known you for at least five (05) years. DO NOT INCLUDE RELATIVES.

Personal Reference 01

PR01: Address

PR01: City / State / Zip Code

PR01: Home and Work Phone Numbers

PR01: Contact email address

PR01: Relationship to Applicant

Personal Reference 02

PR02: Address

PR02: City / State / Zip Code

PR02: Home and Work phone numbers

PR02: Contact Email Address

PR02: Relationship to Applicant

Personal Reference 03

PR03: Address

PR03: City / State / Zip Code

PR03: Home and Work phone numbers

PR03: Contact Email Address

PR03: Relationship to Applicant

Criminal History

Have you ever been arrested, detained or questioned by police concerning a crime?

Yes see attachment

Upload Attachment for Arrest of a Crime

Have your driving privileges ever been suspended, revoked or cancelled?

Yes see attachment

Upload Attachment for Driving Privileges

Have you ever received a traffic citation?

Yes see attachment

Upload Attachment for Traffic Citation

Have you ever committed a serious crime for which you were NOT arrested?

Yes see attachment

Upload Attachment for Serious Crime for which you were NOT arrested

For Office Use ONLY

Volunteer Interest Form

What other skills and/or experience do you possess?

What do you expect to gain from volunteering with CMPD?

What days and times are convenient for you to volunteer?

Do you have a specific Division / Unit location where you would like to volunteer?

Emergency Contacts

Name of Emergency Contact 01

EC01: Address, City, State and Zip Code

EC01: Home Phone Number

EC01: Work Phone Number

EC01: Cell Phone Number

EC01: Contact Email Address

EC01: Relationship to Applicant

Name of Emergency Contact 02

EC02: Address, City, State and Zip Code

EC02: Home Phone Number

EC02: Work Phone Number

EC02: Cell Phone Number

EC02: Contact Email Address

EC02: Relationship to Applicant

Name of Emergency Contact 03

EC03: Address, City, State and Zip Code

EC03: Home Phone Number

EC03: Work Phone Number

EC03: Cell Phone Number

EC03: Contact Email Address

EC03: Relationship to Applicant

The City of Charlotte is committed to making our services and programs accessible to all. Upon request, auxiliary aids, written materials in alternative formats, language access and other reasonable accommodations or modifications will be provided. To make a request, please email Officer Antoine Patterson, Volunteer Liaison Officer or call 704-353-0302 ext. 1.

CMPD Volunteer Unit Application

Applicant Information

Title of Respect

Is Mailing Address different from Residing Address?

Sex

Race

Household Background

Educational Background

Highest Level of Education

Degree Earned

Volunteer History

Health Screening History

How frequently do you consume alcoholic beverages?

Have you ever tried, used or experimented with marijuana?

Have you ever 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 or used a prescription medication prescribed for you when it was not medically necessary?

Military History

Have you ever served in the armed forces?

References

Personal References

Criminal History

Have you ever been arrested, detained or questioned by police concerning a crime?

Upload Attachment for Arrest of a Crime

Have your driving privileges ever been suspended, revoked or cancelled?

Upload Attachment for Driving Privileges

Have you ever received a traffic citation?

Upload Attachment for Traffic Citation

Have you ever committed a serious crime for which you were NOT arrested?

Upload Attachment for Serious Crime for which you were NOT arrested

For Office Use ONLY

Volunteer Interest Form

Current Interests in the Volunteer Program includes [Choose as many as apply]

Emergency Contacts

Acknowledgements

Current Interests in the Volunteer Program includes [Choose as many as apply]