Excellence In Service Yamhill County Sheriff s Office Sheriff Tim Svenson 535 NE 5 th Street, Room 143, McMinnville, Oregon 97128-4595 Business Office: (503) 434-7506 Fax: (503) 472-5330 Jail: (503) 434-7507 : sheriff@co.yamhill.or.us VOLUNTEER/INTERNSHIP APPLICATION Select all programs that you are interested in volunteering for and rate in order of interest with 1 =most interest Admin/Other Admin. volunteers work in the Sheriff s Office, Dog Control, or other areas assisting staff with filing, copying, scanning, case prep, data entry, and other projects that arise on a regular basis and participate and prepare events. Cadets A youth program, between 15 and 20 years of age. Cadets learn a variety of skills and participate in many activities such as Patrol ride-along, parades, Yamhill County Fair and the Oktoberfest in Mt. Angel, OR, in addition to various Law Enforcement training. (Meet weekly) Posse The Posse s purpose is to serve as an equestrian service oriented extension of the Yamhill County Sheriff s Office. The mounted members attend public and private functions such as community parades, fairs, school events and/or act as event security, crowd and traffic control. (Meeting monthly, group rides, events). SAR The purpose of the Search & Rescue (SAR) organization is to assist in various types of searches, assist the Sheriff s Office with various community programs and projects, and be generally available to assist the Yamhill County Sheriff s Office and other county agencies in emergencies. Must attend academy. (1 meeting per month, call outs, etc.) VRU The Volunteer Response Unit, responds to crime scenes to help with scene security, has a high focus on community policing with summer park patrols, National Night Out and Halloween patrols, and develops relationships with the Community. The VRU members promote motorist safety by staging the Sheriff s Office s radar trailer. They participate in area parades for crowd safety. VRU presents educational public awareness displays at many functions throughout the County, often assists in other projects as needed. (1 meeting per month and events) Jail AA NA Bible Study Enrichment Classes, i.e., Anger Management, Parenting Internship Note: To be considered must have required hours and expectations, and fully complete intern section Applicant Name: (Last) (First) (Middle) Other Names Used: (Last) (First) (Middle) Date of Birth: Place of Birth (City, State): Home Address: City: State: Zip: Mailing Address (if different): City: State: Zip: Phone (H): (Cell): (W): (Other): 1: 2: Do you fluently, read, speak, or write any foreign languages? Yes No - --If yes, please list language and indicate level of proficiency: Have you ever been evicted or asked to leave a residence? Yes No - - -If yes, please explain the circumstances and who your landlord was, to include their contact information:
Volunteer Application Form Page 2 INTERNSHIP INFORMATION (complete if applying for an Internship) School Currently Attending: Volunteer Job Interest(s): Projected Term or Start/End Date of Volunteer: Number of Hours Required: Degree(s) Earned: Accumulative GPA: Referred By: Days and Hours Available for Volunteer: Number of Credits Earned for Volunteer: Estimated Graduation Date: School Volunteer Supervisor and Department: Limitations or Special Accommodations Needed: What is your goal in becoming an YCSO intern? *Please provide unofficial transcripts for all colleges or universities you have attended. EDUCATION & FORMAL TRAINING (Please check) Do you have a high school diploma or a GED certificate? Yes No/ which: HS Diploma GED Other List all Colleges, Nursing, Military, Trade, Business, and other schools attended: Name of School Name of School Location City & State Location City & State Course of Study Course of Study Dates Attended Year Graduated/Degree Obtained Dates Attended Year Graduated/Degree Obtained List any currently valid professional / vocational licenses, certifications, skills, registrations, college degrees you hold or checkbox: None REFERENCES PERSONAL (Please list 4 personal references you have known at least one year, and who are different than listed work references and are not related to you or living with you; no references from the same address.) Name of Reference Name of Reference Name of Reference Name of Reference Mailing Address Mailing Address Mailing Address Mailing Address City, State, Zip City, State, Zip City, State, Zip City, State, Zip Phone # Phone # Phone # Phone # Years Known Years Known Years Known Years Known
Volunteer Application Form Page 3 EMPLOYMENT (Please list your last four positions or last ten years of employment history; list the most recent position first. Complete employer information is required to process your application; current salary information is used for risk management purposes only.) Name of Company/Employer Your Title Name of Company/Employer Your Title Your Supervisor Phone # Your Supervisor Phone # Name of Company/Employer Your Title Name of Company/Employer Your Title Your Supervisor Phone # Your Supervisor Phone # Have you ever had any disciplinary actions, been terminated or been asked to resign from a job (paid or unpaid)? Yes please provide the date, name of employer and a statement of the circumstances involved: _ No - - - If yes, BACKGROUND INFORMATION Are you 18 or older? Yes No Are you a U.S. citizen? Yes No - - - If no, list your current visa status and be prepared to provide documentation: Have you ever been the subject of a criminal or civil rights investigation or have you been arrested or charged with any crime or violation? Yes No If yes, please list date, place, charge(s), disposition, and state of occurrence: Have you ever been convicted of a crime? Yes No - - - If yes, please list charges, state of occurrence and explain the circumstances: Have you ever been the subject of an emergency protective order/ restraining order/ stay-away order? Yes No - - - If yes, explain the circumstances: Has your driver s license ever been suspended or revoked? Yes No - - - If yes, please list date(s) and reason(s): Have you previously applied for an Volunteer, volunteer placement or employment at the YCSO or any other law enforcement, corrections, or criminal justice related agency and been denied a placement? If yes, please list agency(s), date(s), and position(s), and reason for denial, if known
Volunteer Application Form Page 4 Are you currently on any type of supervised release, such as probation (including unsupervised and/or bench probation), parole, pre-trial supervision, or electronic monitoring? Yes No - - -If yes, please list: Do you have any pending court cases, including civil matters? If yes, please list Do you currently live with anyone on supervision by the courts, such as probation, parole, pre-trial supervision, electronic monitoring, diversion, etc.? Yes No - - -If yes, please list name(s), types of charges and approximate dates, if known, and your relationship: Have you served in the United States Armed Forces? Yes No - - -If yes, please submit a copy of your DD214 (Member 4 copy); [Note: If you are waiting for the arrival of this document, please make a notation and proceed with submitting your application, however, documentation must be provided prior to final consideration for placement.] If yes, were you ever the subject of any judicial or non-judicial disciplinary action (e.g. Article 15, court martial, company punishment, etc)? Yes No. If yes, please explain the circumstances: DRIVER S LICENSE & INSURANCE COVERAGE VERIFICATION (Provide the following information to document that you hold a valid driver s license and auto insurance. If you do not have a driver s license, please provide state ID card information at bottom of this section.) Your Driver s License Number: State: Expiration Date: Vehicle: Year/Make/Model: Color License Plate # & Exp. Date: No Driver s License State ID Card Only ID Card # /State/Exp. Date_ Distinguishing marks, scars or tattoos*: Important to note: *It is the Policy of the Yamhill County Sheriff s Office that tattoos will not be visible while in any Sheriff s Office uniform. This policy applies to all employees, affiliated representatives and/or volunteers.(ycso policy 3.20) In addition, Non-uniform personnel performing normal Sheriff's Office functions will adhere to the same basic hair code as defined for uniform personnel; but final determination will be at the discretion of the Division Commander. (YCSO policy 3.20) I hereby swear or affirm that there are no willful misrepresentations, omissions, or falsifications of the preceding statements. I authorize a criminal history and driving record check and an investigation of all statements made in this application. I understand that misrepresentation, falsifications, or omission of facts in any documents I submit or statements I make as part of this process, is cause for rejection of my application and/or termination of my Yamhill County Sheriff s Office Volunteer placement or other volunteer duties. SIGNATURE OF APPLICANT DATE
535 NE 5 TH STREET, RM 143, MCMINNVILLE, OR 97128 Release of Information Authorization I hereby authorize the Yamhill County Sheriff s Office to inquire into my background with regard to my character and qualifications. I specifically authorize my current and former employers to furnish records of my service and my reason for departure and other information they may have concerning me, including all information of a confidential or privileged nature; and I do hereby release them from any and all liability for damage on account of furnishing such information. I understand that questionnaires may be sent to any and all references that I have provided in my application process or any other sources that are found during my background investigation. I also understand that other persons or organizations may be contacted for any and all information bearing upon my character and qualifications for internship or volunteer work and request and authorize all persons and organizations so contacted to furnish the requested information. I do hereby release them from any and all liability for damage on account of furnishing such information. I understand that the contents and finding of the background investigation are confidential, and may be used for the purpose of background investigations for internship or volunteer work with the Yamhill County Sheriff's Office. I further understand that neither I nor any persons outside of a law enforcement background investigation process will be granted access to all or any part of the results of this investigation. With the above statements in mind, I hereby waive any and all rights that I or my representatives may have to read, review, or in any way gain knowledge of the content of the completed investigation. Further, I hereby certify that all written or verbal statements made throughout this application process are true and complete, and I understand that any misstatement of material facts will subject me to disqualification, dismissal, and under some circumstances, may result in prosecution for a crime. I hereby release you, your organization and others from my liability or damage that may result from furnishing the information requested. SCHOOL INFORMATION RELEASE AUTHORIZATION I hereby authorize release to the Yamhill County Sheriff's Office any information regarding my school records and transcripts. MILITARY INFORMATION RELEASE AUTHORIZATION I hereby authorize the release of my Military Service Record to the Yamhill County Sheriff's Office, McMinnville, Oregon 97128. I CERTIFY THAT THERE ARE NO MISREPRESENTATIONS, OMISSIONS OR FALSIFICATIONS IN THE FORGOING STATEMENTS AND ANSWERS, AND THAT THE ENTRIES MADE BY ME ABOVE ARE TRUE, COMPLETE AND CORRECT TO THE BEST OF MY KNOWLEDGE AND BELIEF. I FURTHER AGREE AND CONSENT IN ADVANCE TO BEING INVOLUNTARILY DISCHARGED WITHOUT COURSE OR HEARING IF ANY OF THE ABOVE INFORMATION CONTAINS ANY MISREPRESENTATIONS OR FALSIFICATION OR IF ANY MATERIAL INFORMATION HAS BEEN OMITTED. Applicant s Signature: Date: State of Oregon, County of. Subscribed and sworn to before me this day of, 20_. My Commission Expires Notary Signature ROI pg 5 Vol/Intern