Richmond Citizens Crime Watch Patrol
Volunteer Application Form

 


   PART I - Personal Information (Please do not use initials)


          SURNAME:           MAIDEN NAME: 

          GIVEN NAME:           MIDDLE NAME: 

          PERMANENT ADDRESS: 

          TELEPHONE  (HOME):       (WORK): 

          DATE OF BIRTH: (YY/MM/DD)    PLACE OF BIRTH: 

          ARE YOU A CANADIAN CITIZEN?:        YES      NO 
 
          DRIVERS LICENSE NUMBER:        CLASS: 

          IF CURRENTLY EMPLOYED; EMPLOYER/COMPANY NAME: 

          Address:    Position/Title: 

          LENGTH OF EMPLOYMENT:   FROM       TO 

          SPOUSE/COHABITATOR: SURNAME:     GIVEN NAME: 

          DATE OF BIRTH: (YY/MM/DD)  

          NAMES OF ANY CHILDREN AND/OR OTHER PERSONS RESIDING WITH YOU:

            (SURNAME)            (FIRST NAME)             (MIDDLE NAME)               (DATE OF BIRTH)

          PLEASE INDICATE IF YOU ARE INTERESTED IN ANY OF THE FOLLOWING ADDITIONAL

          DUTIES/ACTIVITIES: (Check all that apply)

           Base Operator       Training Officer        Counter Attack
           Special Events      Emergency Call-up List


          
   PART II - Qualifications/ Skills


          LIST ANY TYPE OF SPECIAL SKILLS:

          

          EDUCATION/ TRAINING:

          

          LIST OF LEISURE ACTIVITIES AND INTERESTS:

          

          WHY DO YOU WISH TO VOLUNTEER?

          

          WHAT ARE YOUR EXPECTATIONS OF VOLUNTEERING?

          


Are you willing to complete an initial training program and future training?      Yes    No

Are you willing to work the required hours? (4-6 hours/month)           Yes     No

Are you willing to make a commitment of one year to the program?    Yes     No



I agree that the RCMP may conduct a criminal record search and reliability check and that any inconsistencies will result in the rejection

of my application and that the RCMP has the final authorization for the approval of my application.

              Yes     No



I give my permission to the Royal Canadian Mounted Police to obtain information necessary to qualify me as a volunteer with the Community

Police Station. It is understood that the Royal Canadian Mounted Police will have the final authority in the approval or rejection of my

application. The decision, criteria, or method of arriving at this decision is final and not subject for disclosure and that I will bear no grievance

against the Royal Canadian Mounted Police. I affirm that the information provided is true to the best of my knowledge.

             Name        Date: