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2. 
4. PERSONAL INFORMATION
6. Last Name
7. First Name
8. Middle Inital
10. Address1
12. City
13. State
14. Zip
16. Email address
18. Home Phone
19. Work Phone
20. Cell Phone
22. Date of Birth
23. Place of Birth
25. EMERGENCY CONTACT
27. First Name
28. Last Name
30. Relationship
31. Phone
33. AVAILABILITY TO VOLUNTEER
35. Days of Week*

    1. Monday
    2. Tuesday
    3. Wednesday
    4. Thursday

    1. Friday
    2. Saturday
    3. Sunday
36. Hours
38. PREFERRED VOLUNTEER POSITION (i.e. Administrative/ Community Service Volunteer):
40. Area of Interest
42. EDUCATION
44. High School or GED Diploma earned?
46. College
48. Other
50. LICENSES, CERTIFICATIONS AND SPECIAL TRAINING
52. Professional Licenses and/or Certificates
54. SPECIAL SKILLS AND ABILITIES
56. List special skills and/or hobbies that you would like to use as a volunteer
58. LANGUAGE SKILLS (including sign language)
60. PREVIOUS/CURRENT VOLUNTEER EXPERIENCES
62. Organizations/Responsibilities
64. How did you hear about our volunteer program?
66. EMPLOYMENT
68. Employer
70. Position/Duties
72. Address1
74. City
75. State
76. Zip
78. Previous Employer or Company
79. Dates From - To
    Dates From - To Start Date

    —

    Dates From - To End Date
81. Position/Title or Duties
83. Previous Employer or Company
84. Dates From - To
    Dates From - To Start Date

    —

    Dates From - To End Date
86. Position/Title or Duties
88. REFERENCES
90. Reference 1 Name
91. Home Phone
92. Work Phone
94. Relationship
95. How long known?
97. Reference 2 Name
98. Home Phone
99. Work Phone
101. Relationship
102. How long known?
104. Comments
106. APPLICANT RELEASE STATEMENT
     I am presently an applicant for a volunteer position with the Castle Rock Police Department In order to be considered for such a position, the Police Department needs to obtain verification of past performance. I hereby authorize you to transmit to the Castle Rock Police Department any and all information concerning my past employment performance, including, but not limited to the information required in this form. I do hereby release and so discharge the Police Department or its agents or employees, together with the employer whose name and address appears on this form, or any of its agents or employees, from any liability, claim, or demand of any nature whatsoever, arising out of the dissemination of the information requested herein.
108. By entering my name below, I understand that I am providing an electronic signature which will serve as authorization and verification of the accuracy and completeness of the information I have provided*
     Enter Full Name: First, MI, Last. Signature is required for form submittal.
110. Affirmation:*

     1. By submitting this form, I certify that all statements made on this application are true and complete. (Required)
Leave This Blank:


112. 1. Receive an email copy of this form.
113. Email address

     This field is not part of the form submission.

114. Submit

* indicates a required field