City of Maitland, Florida

GARY T. CALHOUN
CHIEF OF POLICE

Police Volunteer Program Application

Name:

SSN:

Phone Number:

Address:

City:

State:

Zip:

Sex:

(For statistical and criminal history purpose only)

Driver's License Number:

Volunteer Position Sought:

You must be able to answer "yes" to questions 1-3 in order to be considered:

1. Are you at least 19 years of age?

2. Are you a United States Citizen?

3. Do you possess a High School Diploma or GED?

You must be able to answer "no" to questions 4-12 in order to be considered:

4. Has your driver's license being suspended within the past year?

5. Have you received 3 or more moving traffic violations in the past year?

6. Have you used, possessed, or cultivated any illegal controlled substance within the past 3 years?

7. Have you ever been convicted of a felony?

8. Have you ever been adjudged or found to be in contempt of court?

9. Have you ever been convicted of a misdemeanor involving moral turpitude, false statements, perjury or domestic violence?

10. If employed by a law enforcement or corrections agency, are you now under internal investigation?

11. Have you ever resigned as a law enforcement officer while being investigated criminally or administratively?

12. Have you ever resigned from any position after being informed that you were going to be disciplined or terminated?

Personal Information

Have you ever worked for or applied to the Maitland Police Department before?

Position:
Date:

Is there any other language you can read, write, or speak fluently?

Employment History

Describe below the last four jobs you have held, including experience in the military, and part-time, temporary, or volunteer work, even if the company is closed. Begin with your present or most recent employment and work backward. If you've ever worked in law enforcement or corrections (even if more than 4 jobs ago), please list the information.

Present or Most Recent

Employer:
Dates Employed:
Position(s) Held:
Type of Business:
Description of Duties:
Reason for Leaving:

Employer:
Dates Employed:
Position(s) Held:
Type of Business:
Description of Duties:
Reason for Leaving:

Employer:
Dates Employed:
Position(s) Held:
Type of Business:
Description of Duties:
Reason for Leaving:

Employer:
Dates Employed:
Position(s) Held:
Type of Business:
Description of Duties:
Reason for Leaving:

If you answer "yes" to the following, you must type below a full explanation before your application will be considered.

Have you ever been disciplined by any current or past employer(s)?

List each discipline, employer, dates

Have you ever been terminated or asked to resign from a job?

List each employer, reason, date

Additional Information

Other Qualifications
Summarize special job-related skills and qualifications acquired from employment or other experience.

Specialized Skills
(Check Skills/Equipment Operated)

Terminal	Spreadsheet Program:	Production/Mobile Machinery (list)	Other (list)
PC/MAC	Word Proccessing Program:
Typewriter WPM	Shorthand WPM

State any additional information you feel maybe helpful to us in considering your application:

Note to Applicants: DO NOT ANSWER THIS QUESTION UNLESS YOU HAVE BEEN INFORMED ABOUT THE REQUIREMENTS OF THE JOB FOR WHICH YOU ARE APPLYING.

Are you capable of performing in a reasonable manner, with or without a reasonable accommodation, the activities involved in the job or occupation for which you have applied? A review of the activities involved in such a job or occupation has been given.

References

Name:
Phone:
Address:

Name:
Phone:
Address:

Name:
Phone:
Address:

Education Record

Do you have a college Degree?

Type of Degree:

If no degree, how many credits? Course of Study?

Have you received your Florida Law Enforecement Certification, or are you currently attending an academy?

Name of Academy and graduation date:

Criminal History

Because you are applying to a law enforcement agency, you must include information about any arrest, charge, conviction or other criminal activitiy, even if the records are sealted or expunged. If you answer "yes" to any of the following, you must attach a full explanation before your application will be considered.

Have you ever been arrested, received a notice to appear, charged, convicted, pled nolo contendere or pled guilty to any criminal violation, regardless if the record was sealed or expunged?

Explanation:

Have you ever been convicted of any felony and/or misdemeanor?

Explanation:

Have you ever been involved in the sale of illegal drugs?

Explanation:

Have you ever taken anything from an employer without proper permission?

Explanation:

United States Military Record

Have you ever been a member of the United States Armed forces?
(Note: Veterans Preference Form provided with full application)

Have you ever been disciplined or received an Article 15 while in the Military?

List each discipline, dates, and outcome

Branch:
Dates employed:
Specialization:
Types of Discharge:

My signature indicates that all of the information I have provided is complete and accurate. I understand that if I am found to have falsified or omitted ANY information at ANY time in the selection process, I will be disqualified, even if the accurate information would not have disqualified me.

Additionally, I understand that, according to FS 119.071, the Maitland Police Department will be utilizing my Social Security Number in the furtherance of my application and possible employment, to include but not be limited to, conducting a background investigation, tracking and reporting my training records in compliance with CJSTC requirements, tax reporting and benefits information.

Date:
Signature of Applicant:

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