Volunteer Application VOLUNTEER INTEREST (Please Write Legibly) Mounted Patrol Reserve Deputy Water Recovery Unit Chaplain Corps Explorer Post Jail Programs APPLICANT INFORMATION Last Name First M.I. Date Current Street Apartment/Unit # City State ZIP Previous Street City E-mail Apt/Uni t # State Dates Available Number of Hours Requested for Volunteer Work Driver s License Number DL State Are you a citizen of the United States? YES NO If no, are you authorized to work in the U.S.? YES NO Have you ever worked for this company? YES NO If so, when? Have you ever been convicted of a violation of the law other than traffic offenses YES NO If yes, explain EDUCATION High School From To Did you graduate? YES NO GPA College or University From To Expected date of graduation? Degree Other From To Did you graduate? YES NO Degree ACADEMIC AND PROFESSIONAL REFERENCES Please list three professional references. Full Name Relationship
Full Name Relationship Full Name Relationship CURRENT AND PREVIOUS EMPLOYMENT Supervisor Job Title Starting Salary $ Ending Salary $ Responsibilities From To Reason for Leaving May we contact your previous supervisor for a reference? YES NO Supervisor Job Title Starting Salary $ Ending Salary $ Responsibilities From To Reason for Leaving May we contact your previous supervisor for a reference? YES NO MILITARY SERVICE Branch From To Rank at Discharge Type of Discharge If other than honorable, explain DISCLAIMER AND SIGNATURE I certify that my answers are true and complete to the best of my knowledge. If this application leads to an internship, I understand that false or misleading information in my application or interview may result in my release an internship with Washington County Sheriff s Office. Signature Date
List experiences, skills or abilities you have relating to the volunteer position you are seeking: List academic, previous volunteer or personal interests that you have relating to the volunteer position you are seeking As a representative of Washington County Sheriff s Office, what do you believe is your volunteer mission? Is there anything else you would like us to know about you? What is the next step in the volunteer process? Washington County Sheriff s Office will review your volunteer application. You will be required to attend a volunteer orientation and submit your fingerprints for a criminal history check. You will be asked to sign an Authorization to Release Information in order to examine your suitability to serve as a volunteer for the Washington County Sheriff s Office. If selected, you will also be required to obtain a volunteer identification photo. Questions regarding the volunteer programs may be directed: Sergeant Rebecca Broome
Sheriff s Administration 651-430-7651 Rebecca.broome@co.washington.mn.us RETURN THIS APPLICATION TO: Washington County Sheriff s Office 15015 62 nd Street North Post Office Box 3801 Stillwater MN 55082-3801 Volunteer applications and additional questions can be directed to the following employees based upon your areas of interest: Mounted Patrol Explorers Post Deputy Matt O Hara Sergeant Tim Harris 651-430-7824 651-430-7820 Matt.Ohara@co.washington.mn.us timothy.harris@co.washington.mn.us Reserve Deputy and Water Recovery Unit Chaplain Corps Sergeant Kyle Schenck Commander Cheri Dexter 651-430-7864 651-430-7855 Kyle.schenck@co.washington.mn.us Cheri.dexter@co.washington.mn.us Jail /Offender Programs Senior Programs Coordinator Bill Hoffman 651-430-7927 William.hoffman@co.washington.mn.us Washington County does not discriminate on the basis of race, color, national origin, sex, religion, age, and handicapped status in employment or the provision of services. AUTHORIZATION TO RELEASE INFORMATION (MINNESOTA STATUTE 13.05, SUBDIVISION 4) TO: I hereby authorize and grant consent to the Washington County Sheriff s Office, its agents and/or representatives to obtain and collect information about me, including information that has been classified as private, as defined by Minnesota Statute 13.02, Subdivision 12. The information includes all data collected, created, received, retained, or disseminated relating to my dealings with an individual or agency. I understand that the information gathered will aid in determining my suitability for a volunteer position with the Washington County Sheriff s Office.
This authorization is valid for one year, but I have the right to cancel it by providing a written notice. A photocopy of this authorization will be treated in the same manner as the original. Full Name (Print): Other Names Used: Date of Birth: (Signature) (Date) AUTHORIZATION TO RELEASE INFORMATION TO: Minnesota Department of Public Safety/Accident Records FROM: Last Name First Name M.I D.O.B.: MN Driver s License or ID # I,, do hereby authorize Minnesota Department of Public Safety to release to the Washington County Sheriff s Office, its agents and/or representatives all information pertaining to my motor vehicle accident history in the state of Minnesota. The information may include all data collected, created, received, retained or disseminated by your Department. I understand that the information gathered will aid in determining my suitability for employment with the Washington County Sheriff s Office.
This authorization shall be valid for a period of one year, but I reserve the right to cancel the authorization at any time prior to that expiration by providing written notice to the Washington County Sheriff s Office or to you. A photocopy of this authorization will be treated in the same manner as the original. Signature: Date: