WILLIAM PATERSON UNIVERSITY POLICE DEPARTMENT 300 POMPTON ROAD WAYNE, NJ Dear Applicant:

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1 WILLIAM PATERSON UNIVERSITY POLICE DEPARTMENT 300 POMPTON ROAD WAYNE, NJ Dear Applicant: The William Paterson University Police Department would like to thank you for your interest in a volunteer position on the Domestic Violence Response Team (DVRT). We welcome all those who are interested in dedicating their time and energy for this worthwhile service. We would like to take this opportunity to detail the qualifications and characteristics which applicants should posses, as well as explain the program and process for application. The William Paterson University Police Department, in collaboration with Passaic County Women s Center, has developed a program to better serve the victims of domestic violence that we encounter on a daily basis. Due to the special circumstances of domestic violence victimization, it is necessary to seek the assistance of volunteers from the community to participate as trained team members. As a team member, volunteer, individuals will initially receive forty hours of training. In Fall-2012 training is being conducted on campus every Friday between 10am and 2pm beginning September 7, 2012 ending November 16, 2012; in addition several Saturday sessions will be scheduled during this time The team will provide twenty-four hour a day, seven day a week service to domestic violence victims, during the Fall and Spring Semesters. Those victims of domestic violence who are encountered by the William Paterson University Police Department will be referred to meet with a DVRT member. DVRT members will assist the victim in a variety of ways, ultimately providing support and information to help them make informed decisions on the options that are available to them. In order to accomplish the goals and objectives of this program, it is necessary for volunteers to possess minimum qualifications as listed below: 18 years of age or older Student, faculty or staff of William Paterson University No criminal history No prior history as a defendant in a domestic violence related matter Available to be on-call a minimum of 48 hours per month Ability to communicate well with others Good listener Sensitivity to victim s feelings and concerns Desire to help others Availability to participate in initial and ongoing domestic violence training 1

2 Bilingual individuals and persons fluent in American Sign Language are encouraged to participate in order to assist those victims who have special language and cultural needs or issues. Applicants will be required to participate in the forty hour initial training course. This course will be provided by the Passaic County Women s Center. Following certification, volunteers will be assigned to the Team and will immediately enter the on-call rotation. On-call rotations for volunteers will require availability of 48 hours a month. Shifts have been broken down into 6 4- hour shifts a day to accommodate school and work schedules. Volunteers will need to supply cellular phone numbers for on-call contact. The William Paterson University Police Department will contact volunteers to respond to Campus Police Headquarters to meet with the victim. Attached is an application for consideration to be a volunteer for the Domestic Violence Response Team DVRT. Please complete this application, and the attached waiver form, and return them to William Paterson University Police Department, attention Detective Sergeant DeSimone. After your application is received it will be reviewed for acceptance, and the William Paterson University Police Department will conduct an extensive background investigation. Upon successful completion of the background investigation, you will be contacted for a personal interview. The interview process is the final step in the application procedure, and successful completion of the interview process may result in an offer for a volunteer position. Once again, the William Paterson University Police Department thanks you for your interest in the Domestic Violence Response Team. We recognize the importance of the community in our endeavor to provide enhanced services to victims of domestic violence. Without the assistance of community volunteers it would not be possible to operate the Domestic Violence Response Team. Sincerely, Detective Sergeant Ellen DeSimone Detective Sergeant Ellen DeSimone William Paterson University Police Department DVRT Liaison Officer 2

3 WILLIAM PATERSON UNIVERSITY APPLICATION FOR DOMESTIC VIOLENCE RESPONSE TEAM PERSONAL HISTORY - - Full name: Last, First, Middle Social Security Number Date of birth: / / Month, Day, Year Place of birth: City, State/Country Permanent Address: How long have you resided at your Permanent Address? Campus or Local Address (if different from above): Local Phone #: ( ) - Cell Phone #: ( ) - EDUCATIONAL DATA List schools attended. Include name of school, location, dates attended "from - to", course pursued, date graduated, degrees or diplomas. What professional license(s) do you possess? List your proficiency in any foreign language as "slight", "good", "fluent": LANGUAGE SPEAK UNDERSTAND READ WRITE 3

4 REFERENCES Give three (3) references (not relatives, former or present employers or fellow employees) who are responsible adults. Complete Name: Number of years acquainted: Residence Address: Occupation: Home/Work/Cell Number: ( ) - Complete Name: Number of years acquainted: Occupation: Residence Address: Home/Work/Cell Number: ( ) - Complete Name: Number of years acquainted: Occupation: Residence Address: Home/Work/Cell Number: ( ) - COURT RECORD Have you ever been arrested or charged with any criminal violation? YES NO If "yes", give date, place, charge, disposition and details: Have you ever been arrested, charged or summoned with any offense including but not limited to Domestic Violence, disorderly persons offenses, motor vehicle violation (ie. Suspended driver s license, D.U.I), as an adult or a juvenile? YES NO If "yes", give date, place, charge, disposition and details: Have you ever been fingerprinted? (exclude this application process): YES NO If "yes", list when, where and purpose: 4

5 Have you ever been a victim, witness or named in a William Paterson University Police Report or Residence Life Communication Report? YES NO If "yes", give dates and details: REASON FOR APPLYING FOR VOLUNTEERING Please explain your reasons for applying as a volunteer to the William Paterson University Domestic Violence Response Team. (Use an additional sheet if necessary) I understand that any appointment tendered me will be contingent upon the results of my criminal and judicial background checks and successful completion of training. I am aware that willfully withholding information or making false statements on this application will be the basis for dismissal from the William Paterson University Domestic Violence Response Team. I agree to these conditions and I hereby certify that all statements made by me on this application are true and complete, to the best of my knowledge. Signature of Applicant Date 5

6 Domestic Violence Response Team Release Authorization I hereby certify that I have no health problems and am physically fit and sufficiently able to volunteer with the William Paterson University Police Department Domestic Violence Response Team. I fully understand and agree to assume all risks involved in any and all duties that I perform in a volunteer capacity on behalf of or in connection with the William Paterson University Police Department Domestic Violence Response Team. I agree to hold the William Paterson University and its affiliations harmless for any injury(s), loss or damages which I might sustain during the course of my volunteer duties. I agree not to consume or be under the influence of alcoholic beverages or drugs while participating. I agree to obey all policies and procedures related to the activities involved in the William Paterson University Police Department Domestic Violence Response Team. I, the undersigned, have read and understand the foregoing agreement, warnings, release, and assumption of risk. I further attest that all facts relating to my physical condition and age are true and accurate. Printed Name Signature of Applicant Date Domestic Violence Response Team Waiver Form I,, in consideration of the William Paterson University my voluntary participation in the Domestic Violence Response Team, I agree to the following: I release William Paterson University and its agents, members of the Campus Violence Prevention Program Board and its agents, and volunteers from all liability for damage and injuries which I may sustain as a result of my voluntary participation as a member of the William Paterson University Police Department Domestic Violence Response Team. I specifically assume all risks associated with my participation in the William Paterson University Police Department Domestic Violence Response Team and associated events related activities, and the risk of damage or injury from any cause, action, omission or occurrence during my activities as a William Paterson University Police Department Domestic Violence Response Team member. I acknowledge that I have read these terms and conditions and fully understand that this is a waiver and release of liability. Printed Name Signature of Applicant Date Please return completed application, release authorizations and waivers to Det. Sgt. Ellen DeSimone William Paterson University Police Department Headquarters 300 Pompton Road, Wayne, NJ The first building on the left when using Entry One. Entry One is on Pompton Road near the Catholic Ministry Building and Camp Veritans 6

7 DOMESTIC VIOLENCE VICTIM RESPONSE TEAM AUTHORIZATION & RELEASE To: All Courts, Probation Departments, Selective Service Boards, Hospitals, Employers, Educational and other Institutions and Agencies with exception. I,, am making application for to become a member of the William Paterson University Police Department Domestic Violence Response Team. As a result, an investigation is being conducted to determine my eligibility. Therefore, you are authorized to release to the William Paterson University Police Department or its representative any and all information, documentary or otherwise pertaining to me that they may request. A photocopy of this authorization will be considered as effective and valid as the original. Signature Date Sworn and subscribed to before me at this date Notary Public of New Jersey 7

8 Passaic County Women s Center Fall 2012 DVRT Training Dates All Sessions 10:00am 2:00pm Friday, September 14 Friday, September 21 Saturday, September 22 Friday, September 28 Friday, October 5 Friday, October 26 Friday, November 2 Saturday, November 3 Friday, November 9 Friday, November 16 Friday, October 19 Please contact Theresa Bivaletz for more information and to apply: , tbivaletz@njaconline.org Training Location: William Paterson University 300 Pompton Road Wayne, NJ Room: Parking is available in Commuter Lots 4 & 5, Enter thru Entry 4