VOLUNTEER/INTERN APPLICATION 1
Volunteer/Intern Application for the Montgomery County Department of Police Community Services Division
100 Edison Park Drive Gaithersburg, MD 20878 Phone (240) 773-5625 Fax (240) 773-5635
Important Information and Instructions for Individuals interested in becoming Volunteers or Interns with the Montgomery County Department of Police
It is our policy and practice to select and assign applicants based on qualifications without regard to race, religion, color, national origin, gender, marital status, age, or disability. Each applicant appointed to a position must meet all the requirements of that position. We will make every effort to identify a suitable and acceptable assignment for applicants, but cannot guarantee that everyone will be placed.
Individuals who apply to the Montgomery County Department of Police are subject to a comprehensive background investigation, since they may have access to sensitive and confidential information. The background investigation may include (but not necessarily be limited to) driving record, criminal history, and reference check of employers, friends and acquaintances. This information, along with your photograph, will be kept on file.
By submitting a completed and signed application, you are giving the Department of Police consent to conduct a background investigation.
Instructions for Applicants:
· You can type your responses in this application (pages 2 -6). Please remember to SAVE your document before printing the document.
· Remember to complete all 5 pages of this application
· Remember to sign and date the last page of the application (page 6)
· Please include a photocopy of your driver’s license (or other picture identification) with
your application.
· Because the form requires a signature, it must be mailed to the address listed below:
100 Edison Park Drive
Gaithersburg, MD 20878
Phone (240) 773-5625
Fax (240) 773-5635
· Application follows …
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1. For which position are you applying? Volunteer InternContact Information
2. Mr./Mrs./Ms. Last name, First name, Middle name3. Your Current Address:(Street, City, State, Zip code)
4. Home Phone: 5. Office Phone: 6. Cell/Pager:
7. E-mail address:
8. Soc Sec #: 9. Date of Birth:(MM/DD/YY) 10. Gender (M / F):
11. List the name, relationship, and phone number of someone we can contact in an emergency:
12. Please list previous addresses (and approximate dates of residence) for the last five years:
13. Are you a U. S. citizen?: Yes No
If you are not a U.S. citizen, please answer questions 14 through 19.
14. Country of Birth: 15. Current Citizenship:
16. Type of Visa: 17. Expiration Date(Mo/Day/Yr):
18. Alien Registration No.: 19. Date Issued (Mo/Day/Yr):
20. Do you have or have you ever had a Maryland Driver's License? Yes No
21. MD License No.: 22. Expiration Date (Mo/Day/Yr):
23. Do you now have or have you ever had a Driver's License in another state? Yes No
If yes, list State, License No., and Expiration Date of License:
24. State 25. Lic No.: 26. Exp Date (Mo/Day/Yr):
27. State 28. Lic No.: 29. Exp Date (Mo/Day/Yr):
30. State 31. Lic No.: 32. Exp Date (Mo/Day/Yr):
Please provide the following information about the vehicle you normally operate:
33. Make: 34. Model 35. Color:
36. Tag #: 37. State:
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Education
38. Check the highest level of education completed:AA BA/BS MA/MS PhD Other:
If you are currently enrolled in school, please provide the following information:
39. Name of School: 40. Area of Study:
41. Anticipated Graduation Date: 42. Degree:
43. Other Training/Licensure/Certification:
Skills
Language Skills other than English: (Rank language skills 1 to 5, where 5 is excellent)44. Language: 45. Speaking Ability: 46. Read/Write Ability:
47. Language: 48. Speaking Ability: 49. Read/Write Ability:
50. Office Skills:
51. Computer Skills:
52. Other Special Skills:
Interests
Office Assistance / Training / Computer SupportAlcohol Enforcement / Customer Service / Translation/Interpretation
Policy Development / Media/Public Relations / Victim Assistance
Research/Planning / Records Management / Special Community Events
Community Policing / Working With Youth / Work With Senior Citizens
Station Operations / Writing/Editing
53. Other Describe:
54. How did you hear about the Volunteer/Intern Program?
55. To assist us with placement, please tell us briefly why you wish to volunteer/Intern with the
Department of Police:
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Work Experience
56. Describe previous volunteer or intern positions or experience (Scouts, PTA, Church, School, etc.) Also please describe any intern or volunteer experience with other law enforcement agencies. (Specify agency and dates of service)57. Current Status: Employed full-time part-time, Retired, Student, Unemployed
58. Current/most recent Employer:
59. Address:
60. Dates employed: 61. Company Phone #:
62. Job Title/Occupation: 63. Hours /week:
64. Supervisor's Name: 65. Phone #:
66. Previous Employer:
67. Address:
68. Dates employed: 69. Company Phone #:
70. Job Title/Occupation: 71. Hours /week:
72. Supervisor's Name: 73. Phone #:
Military Experience
74. Have you ever served in the armed forces ? Yes No75. Country: 76. Dates of Service:
77. Branch of Service: 78. Rank:
79. Specialty: 80. Type of Discharge:
Availability and Schedule
Volunteers are asked to contribute a minimum of 8 hours per week for a period of no less than 6 months, if possible.81. Check the days that you are available.
Sunday Monday Tuesday Wednesday Thursday Friday Saturday
82. Check the time of day you prefer. Mornings Afternoons Evenings Midnights
83. Expected length of commitment (6 months, year, unlimited, etc.)
84. When will you be available to start?
85. Geographic area of Montgomery County (or a specific location) where you would prefer to work :
86. Means of Transportation: Private Vehicle Public Transportation
87. Do you require any special accommodations to facilitate your volunteering?
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Information Required for Background Check
88. Have you ever been arrested or convicted of a crime? Yes No89. If yes, please explain:
References (please do not list relatives):
First Reference:
90. Name: 91. Day Phone:
92. Address:
93. Relationship:
Second Reference:
94. Name: 95. Day Phone:
96. Address:
97. Relationship:
Third Reference:
98. Name: 99. Day Phone:
100. Address:
101. Relationship:
Fourth Reference:
102. Name: 103. Day Phone:
104. Address:
105. Relationship:
Individuals who apply to the Montgomery County Department of Police are
subject to a comprehensive background investigation, since they may have access
to sensitive and confidential information. The background investigation may
include (but not necessarily be limited to) driving record, criminal history, and
reference check of employers, friends and acquaintances. This information, along
with your photograph, will be kept on file.
STATEMENT OF CONSENT AND AUTHORIZATION FOR RELEASE OF INFORMATION
I,______, do hereby authorize a review of all
records, or any part thereof, concerning me, by a duly authorized agent of
the Montgomery County, MD, Department of Police, whether the said records are
public or private, and including those that may be deemed to be privileged or
confidential in nature. I understand should any statement I have made prove to be
false, misleading, or erroneous (for whatever reason), it may result in rejection
of my application and / or discharge from the Department of Police.
______
Signature Date
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