POLK COUNTY SHERIFF S OFFICE DES MOINES AREA COMMUNITY COLLEGE APPLICATION FOR CRIMINAL JUSTICE CLUB

Transcription

1 POLK COUNTY SHERIFF S OFFICE DES MOINES AREA COMMUNITY COLLEGE APPLICATION FOR CRIMINAL JUSTICE CLUB DATE / / NOTICE: APPLICATIONS MUST BE TYPEWRITTEN OR CLEARLY PRINTED IN BLACK INK. ALL QUIESTIONS MUST BE ANSWERED. IF NOT APPLICABLE, INDICATE N/A (NOT APPLICABLE). IF SPACE PROVIDED IS NOT SUFFICIENT FOR COMPLETE ANSWERS OR YOU WISH TO FURNISH ADDITIONAL INFORMATION, ATTACH SHEETS OF THE SAME SIZE PAPER AS THIS APPLICATION, NUMBER & INCLUDE YOUR NAME ON THE SHEETS TO CORRESPOND WITH THE QUESTION. PERSONAL HISTORY STATEMENT FULL NAME S.S.N. STREET ADDRESS HOME PHONE ( ) CITY STATE ZIP MALE FEMALE DATE OF BIRTH / / AGE RACE ARE YOU A U.S. CITIZEN? PLACE OF BIRTH HEIGHT WEIGHT COLOR OF EYES COLOR OF HAIR SCARS, MARKS, OR TATTOOS LIST ALL NAMES YOU HAVE EVER USED

2 EDUCATION RECORD HIGH SCHOOL NAME, ADDRESS AND DATES COLLEGE OR UNIVERSITY DATES, MAJOR AND DEGREE OTHER EDUCATION, TRAINING OR SPECIAL SKILLS YOU POSSESS WERE YOU EVER DISMISSED FROM A SCHOOL OR WAS DISCIPLINARY ACTIONS TAKEN AGAINST YOU? YES NO IF YES, TYPE OF ACTION LIST AWARDS, HONORS, CITATIONS, RECOGNITION AND POSITIONS HELD IN SCHOOL CLUBS AND OTHER ORGANIZATIONS THAT YOU HAVE RECEIVED.

3 EMPLOYMENT LIST CHRONOLOGICALLY, ALL EMPLOYMENT NAME DATES TO ADDRESS CITY/STATE PHONE ( ) - POSITION NAME DATES TO ADDRESS CITY/STATE PHONE ( ) - POSITION NAME DATES TO ADDRESS CITY/STATE PHONE ( ) - POSITION HAVE YOU EVER BEEN DISMISSED/FIRED FROM ANY JOB? YES NO (IF YES, PLEASE EXPLAIN)

4 OPERATOR S LICENSE ARE YOU A LICENSED MOTOR VEHICLE OPERATOR? (IF YES, LIST STATE(S) YOU ARE LICENSED IN AND LICENSE NUMBERS) HAS YOUR DRIVER S LICENSE EVER BEEN SUSPENDED, REVOKED OR DENIED IN THIS OR ANY OTHER STATE. (IF YES, EXPLAIN) COURT RECORD HAVE YOU EVER BEEN ARRESTED OR CHARGED WITH ANY VIOLATION, INCLUDING TRAFFIC? (IF YES, LIST DATE, PLACE, CHARGE, DISPOSITION AND DETAILS) HAVE YOU EVER BEEN A PLAINTIFF OR DEFENDANT IN ANY COURT ACTION? YES NO (IF YES, LIST DATES, PLACE, COURT, NAMES OF PARTIES INVOLVED AND FINAL DISPOSITION)

5 RELATIVES FATHER EMPLOYER ADDRESS CITY/STATE BIRTH DATE / / PHONE ( ) - MOTHER EMPLOYER ADDRESS CITY/STATE BIRTH DATE / / PHONE ( ) - LIST THREE REFERENCES WHO ARE NOT RELATED TO YOU NAME ADDRESS YEARS AQUAINTED PHONE ( ) - OCCUPATION NAME ADDRESS YEARS AQUAINTED PHONE ( ) - OCCUPATION NAME ADDRESS YEARS AQUAINTED PHONE ( ) - OCCUPATION DO YOU HAVE ANY PHYSICAL DISABILITY, HANDICAP OR ILLNESSES, WHICH WOULD LIMIT YOUR PARTICIPATION? YES NO (IF YES, EXPLAIN)

6 MISCELLANEOUS DATA LIST ANY HOBBIES, SPORTS THAT YOU ARE CURRENTLY INVOLVED IN: WHO DO YOU WANT TO PARTICIPATE IN THIS CLUB? IDENTIFY YOUR INTERNSHIP PREFERENCE AND CAREER GOAL(S) ARE THERE ANY ADDITIONAL REMARKS YOU WOULD LIKE TO MAKE? I UNDERSTAND THAT ANY APPOINTMENT TENDERED TO ME WILL BE CONTINGENT UPON THE RESULTS OF A COMPLETE BACKGROUND INVESTIGATION. I AM ALSO AWARE THAT WITHHOLDING ANY INFORMATION OR MAKING FALSE STATEMENTS OF ANY KIND ON THIS APPLICATION WILL BE GROUNDS FOR EXCLUSION. I HEREBY SWEAR AND AFFIRM THAT EACH STATEMENT AND ALL INFORMATION IN OR SUPLLEMENTING THIS APPLICATION IS COMPLETE, TRUE AND ACCURATELY RECORDED TO THE BEST OF MY KNOWLEDGE. I UNDERSTAND THAT PROVIDING FALSE, MISSLEADING AND/OR INCOMPLETE INFORMATION ON THIS APPLICATION IS GROUNDS FOR EXCLUSION. I UNDERSTAND AND AGREE TO THE CONDITIONS SET FORTH IN THE RELEASE OF LIABILITY. SIGNATURE OF APPLICANT DATE / /

7 Respect for Persons CRIMINAL JUSTICE TODAY CLUB RULES OF ETHICAL AND PROFESSIONAL CONDUCT AND REGULATIONS Des Moines Area Community College and the Polk County Sheriff s Office place a high value on human relations, human diversity and human rights. Consistent with these values, the college and sheriff s office strive to maintain an environment that is characterized by mutual respect for all individuals. Such an environment has no place for harassment or discrimination based on race, gender, religion, national origin, age, veteran status or disability; such behavior will not be tolerated. As befitting the criminal justice club s commitment to its public service mission, member s faculty and professional advisors are expected to treat one another, students and the general public in a cordial and respectful manner. The following behaviors are specifically prohibited: 1. Disorderly conduct, to include but not limited to, using discriminatory, abusive or threatening language, fighting, provoking a fight, or attempting bodily harm or injury to another club member or individual or threatening physical action or injury on school or sheriff s property or during club activities; or other conduct which threatens or endangers the health, safety or well-being of any person. 2. Sexual harassment of professional advisors, students, club members, customers, visitors, vendors or any other person on D.M.A.C.C. or sheriff s department property or during any activities. Respect for Property Members of the college community must be responsible caretakers of the schools and sheriff s office resources. Consistent with this value, all club members are expected to exercise reasonable care in the use of college or sheriff s office property and to report any damage to any property to their professional advisors and/or other appropriate club officers. The following activities are specifically prohibited: 1. Willful or negligent damage to college or sheriff s office property. 2. Theft or dishonesty. 3. Tampering with or wantonly destroying college or sheriff s office data, records or other information; gaining unauthorized access to such information; disclosing confidential information; or otherwise misusing college or sheriff s office data or information.

8 4. Unauthorized use of college or sheriff s office vehicles, mail services identification, telephones, computers or computer equipment. 5. Soliciting, collecting money, or circulating petitions on college or sheriff s office property at any time without permission of the professional advisors or designated club officers. The Standards of Safety The club is committed to maintain the safety and security of all persons on college or sheriff s office property and during club or club related activities and to maintain a safe and healthful learning environment. Specific prohibited activities include: 1. Possession of firearms, explosives, or other lethal materials on college property or during club or school activities, unless provided and instructed by professional club advisors. 2. Possessing, drinking, or being under the influence of intoxicants on any club function; unlawful possession, use or distribution of alcohol on college or sheriff s office property or during club activities; illegally using, manufacturing, possessing, distributing, dispensing, or being under the influence of controlled substances on college or sheriff s office property or during club activities. 3. Refusal to obey security officials, Law Enforcement, Civil Defense personnel, or other proper authorities in emergencies. 4. Failure to comply with safety rules, regulations or common safety practices. 5. Failure to report an accident involving an on-the-job injury or damage to college or sheriff s office property. 6. Smoking in non-designated areas. Dress Code Due to the nature of reflecting a positive image to the sheriff s office and the college, a dress code must be enforced. This is used to create a positive image of both the club and the sheriff s office to the general public. The following rules shall be enforced: 1. Clothing must not contain any logos or writing of any explicit nature. 2. Pants cannot bag, sag, drag or have slits. 3. No midriff or underwear should be exposed at any time. 4. Excessively tight or baggy clothing cannot be worn. 5. Clothing may not be ripped or torn, even if styled that way.

9 6. Desirable and well-kept jeans and Dockers type pants are allowed. 7. Overalls, spandex or dance pants may not be worn. 8. Shorts must be no shorter than 2 inches above the knee. 9. Skirts must be no shorter than 2 inches above the knee, and not have slits that are higher than 2 inches above the knee. 10. No thongs or beach shoes may be worn. 11. Hats and sunglasses shall not be worn inside the building. Exceptions and additional requirements to the dress code may be made in supervised physical activities, some extracurricular activities, or club-sponsored events as determined by the advisor. Exceptions shall be made upon certification from a physician of the club member. The club advisors and/or officers have the right to ask a student to change his/her dress or personal grooming habits if it is deemed inappropriate or disruptive to the educational environment. Repeat violations of the dress and grooming code shall be considered defiance of authority and may result in suspension or termination of any club participation. General Conduct All club members shall be required to learn and obey the following rules. Club members violating these rules shall be subject to disciplinary action and/or dismissal. 1. Club members shall not engage in unbecoming conduct, which tends to bring discredit on the Department or their school. 2. Club members shall not use profane or intentionally insulting or degrading language or actions toward any other member of the sheriff s office or to any citizen. Members shall be courteous and tactful in the performance of their duties and shall promptly respond to all reasonable requests for assistance. Members shall refer to sworn deputies and advisors by their appropriate rank and last name unless otherwise directed. 3. Club members shall treat the official business of the Department as confidential and shall disseminate information regarding departmental business or operations only as permitted by supervisory staff. 4. Club members driving county vehicles shall pay strict adherence to traffic laws and shall wear seat belts when driving or riding.

10 Summary The Criminal Justice Today Club reserves the right to cancel membership to any member of the club at anytime for any form of violation of the above rules and regulations. The club also reserves the right to remove any member of the club at anytime by the majority vote of all club officers and professional advisors for any form of non-professional conduct. ANY MEMBER OF THE CRIMINAL JUSTICE TODAY CLUB WITH ANY INTENTION OF MISSREPRESENTATION OF THEMSELVES OR OTHER CLUB MEMBERS AS EMPLOYEES OR OFFICERS OF THE POLK COUNTY SHERIFF S OFFICE IS GROUNDS FOR IMMEDIATE DISMISSAL FROM THE CLUB. Bi-Laws last revised April 13, 2004

11 ACKNOWLEDGMENT OF UNDERSTANDING I acknowledge that I have read the attached club rules of ethical and professional conduct and fully understand them. I affirm that I am granted the privilege to attend and take part in any of the Criminal Justice Today Club functions. Due to the nature of being associated with the Polk County Sheriff s Office in the club, I assume full responsibility of all my actions as to my conduct in representing this club both at school, club functions, and in my everyday life. I also fully understand that any violation of these rules or conduct can or will result in termination of my club membership. I fully understand and agree to accept and follow the rules as set by the Criminal Justice Today Club, its officers, as well as professional and faculty advisors. Participants Name (print) Signature Date

12 POLK COUNTY SHERIFF S OFFICE SHERIFF WILLIAM MCCARTHY Administrative Office Phone (515) Midland Building th Avenue Suite 112 Fax (515) Des Moines, Iowa RELEASE OF LIABILITY THE UNDERSIGNED, AS A PARTICIPANT IN THE POLK COUNTY SHERIFF S OFFICE AND DMACC CRIMINAL JUSTICE CLUB AND THE POTENTIAL USER AND OBSERVER OF ITS TRAINING TECHNIQUES, EDUCATIONAL INFORMATION, WORK ASSIGNMENTS AND EQUIPMENT, RECOGNIZE AND AGREE THAT THERE ARE CERTAIN RISKS AND DANGERS ASSOCIATED WITH PARTICIPATION IN SUCH LAW ENFORCEMENET ACTIVITIES. UNDERSTANDING THE RISKS AND CONSIDERATION OF UNDERSIGN S DESIRE TO PARTICIPATE IN THE POLK COUNTY SHERIFF S OFFICE AND DMACC CRIMINAL JUSTICE CLUB AS A MEMBER RECEIVING TRAINING AND EDUCATION IN LAW ENFORCEMENT WORK, THE UNDERSIGNED DOES HEREBY ASSUME ALL RISK OF PERSONAL INJURY (INCLUDING DEATH) AND OF PERPERTY LOSS AND DAMAGE INVOLVED IN CONNECTION WITH PARTICIPATION IN SAID EDUCATIONAL TRAINING, OBSERVATION, AND DRIVERS PROGRAM; AND ACTING FOR MYSELF, MY HEIRS AND ASSIGNED, DO HEREBY RELEASE, ACQUIT AND FOREVER DISCHARGE POLK COUNTY, THE DES MOINES AREA COMMUNITY COLLEGE, THE POLK COUNTY SHERIFF S OFFICE, OFFICERS, EMPLOYEES, REPRESENTATIVES AND AGENTS INDIVIDUALLY AND COLLECTIVELY FROM, AND AGREE TO HOLD THEM HARMLESS AGAINST, ANY AND ALL LIABILITY, INCLUDING CLAIMS AND SUITS AT LAW OR IN EQUITY, FOR ANY INJURY, FATAL OR OTHERWISE OR FOR ANY PROPERTY LOSS OR DAMAGE WHICH MAY RESULT FROM PARTICIPATION IN SAID CLUB. LIKEWISE, THE UNDERSIGNED, AS THE PARENT/GUARDIANS/CUSTODIANS OF THE ABOVE NAMED MEMBER PARTICIPANT, UNDERSTAND THAT CERTAIN DANGERS AND RISKS ARE ASSOCIATED WITH PARTICIPATION IN SAID CLUB. UNDERSTANDING SUCH RISKS AND IN CONSIDERATION OF THE LEARNING OPPORTUNITIES AVAILABLE TO THE ABOVE NAMED PARTICIPANT, WE DO HEREBY GIVE OUR CONSENT TO ABOVE NAMED MEMBERS PARTICIPATION IN THE POLK COUNTY SHERIFF S OFFICE AND DMACC CRIMINAL JUSTICE CLUB AND ACTING FOR OURSELVES, OUR HEIRS AND ASSIGNS, DO HEREBY RELEASE, ACQUIT AND FOREVER DISCHARGE POLK COUNTY, THE SHERIFF S OFFICE, ITS OFFICERS, EMPLOYEES, REPRESENTATIVES AND AGAINST, ANY AND ALL LIABILITY, INCLUDING CLAIMS AND SUITS AT LAW OR IN EQUITY, FOR ANY INJURY, FATAL OR OTHERWISE OR FOR ANY PROPERTY LOSS OR DAMAGE WHICH MAY RESULT FROM PARTICIPATION IN SAID CLUB. WE HAVE READ THE FOREGOING RELEASE AND UNDERSTAND ITS TERMS AND FREELY AND VOLUNTARILY HAVE SIGNED THE SAME. PARTICIPANT PARENT/GUARDIAN/CUSTODIAN DATE / / DATE / / Accredited by the Commission on Accreditation for Law Enforcement Agencies, American Correctional Association and National Commission on Correctional Health Care