Volunteer Application for Citizen Patrol

Thank you for applying for the Citizen Patrol pilot program in Sun City
Festival and Festival Foothills. Our next Training event is scheduled
for August 6th at 9:00 AM in the Sage Center. It will last
approximately three hours. Your completed application needs to be
faxed or e-mailed to Sgt. Griffis by July 28th, 2011 so you can
participate. A couple of clarifying points:
1. You must complete both the Volunteer Application and
Background Check documents.
2. You must get the Background Check document notarized. You

can do that at the Sage Center for a nominal fee, or from some
other authorized notary of your choosing.
3. You can either fax (623-349-6506) or e-mail a PDF of the

completed, notarized application documents to Sgt. Griffis

cgriffis@buckeyeaz.gov
4. The Application must be received by Sgt Griffis by July 28th.
5. For more information, feel free to contact either your Neighbor

Liaison, Dana Kovach (dpkovach@gmail.com) or Sgt. Griffis at

his e-mail or his phone: ( 623-349-6451)
6. Lets have a great turnout at the August 6th training so we can

make this pilot a great success in our community!

7.

Town of Buckeye
Police Department
Volunteer Application

NAME: Last ______________________ First________________________ Middle Initial _____________

ADDRESS: _____________________________ City ________________ State _______ Zip ____________
PHONE: Home ______________________________ Work ______________________________________
DRIVERS LICENSE # _________________________________ Date of Birth _______________________
EMAIL ADDRESS: _____________________________Soc. Sec #_________________________________
All information provided is held in the strictest confidence and is not for public release.

WHAT AREAS WOULD YOU BE INTERESTED IN VOLUNTEERING? Please check all that apply.
____ Wellness and Vacation Checks
____ Motorist Assist
Other: _____________
____ Helping in the office Filing & Records
____ VIN Etching
___________________
____ Answering phones
____ Finger Printing
___________________
____ Citizen On Patrol
____ Safe Shopping Patrol ___________________
WHEN ARE YOU AVAILABLE TO WORK?
Monday
Tuesday
Wednesday
Mornings
Afternoons
Evenings

Thursday

Friday

Saturday

Sunday

MONTHS YOU ARE AVAILABLE: ____________________________________________________________

WHAT SPECIAL INTERESTS, HOBBIES, SKILLS/TRAINING WOULD YOU LIKE TO SHARE?
___________________________________________________________________________________________
___________________________________________________________________________________________
PRIOR VOLUNTEER EXPERIENCE: ___________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________

Will you have transportation to and from your volunteer job? YES or NO
Do you have any request for reasonable accommodations in order to perform your volunteer duties? YES or NO
Have you ever resigned from a job or volunteer position in lieu of termination? YES or NO
Have you ever been put on administrative leave pending an investigation? YES or NO
Have you ever been terminated from a job or volunteer position? YES or NO If Yes, Why? _________________
___________________________________________________________________________________________
Revised 4/11

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CURRENT OR PREVIOUS EMPLOYER: _________________________________________________

REFERENCES: Please list the names of three people to be contacted for character references:
Name:__________________ Address:______________________________ Phone:___________________
Name: __________________Address:______________________________ Phone: ___________________
Name: __________________Address:______________________________ Phone: ___________________
EMERGENCY CONTACT INFORMATION:
Name:________________________________________________________
Day Phone: ___________________________Evening Phone: __________________________ Relationship: ______________
Address:
_________________________________________City______________________State__________Zip__________________
The Town of Buckeye Police Department is most grateful to those people who are willing to volunteer their time
to assist the Buckeye Police Department through various volunteer programs. As a sign of the changing times,
laws have been enacted to protect both the people we serve and those who contribute their time as volunteers.
This law requests that volunteers working in sensitive areas undergo procedures that may appear on the surface
to be offensive to people giving their time and services. Please bear with us; we are simply taking precautions
against the unscrupulous who may try to penetrate our ranks.
CONDITIONS:
I fully understand, acknowledge and agree that the following will be required before placement in any sensitive
volunteer position.
a. Background Investigation

b. Fingerprinting

c. Substance Abuse Testing

All statements made in this application are true and authorization is given to investigate all matters contained in
the application. Any false statements or misrepresentation on this application will be cause for refusal of
placement or dismissal at any time during my placement.
Signature of Volunteer Applicant ___________________________________________Date _________________

Please Return Application To:

Sgt Griffis
Buckeye Police Department
Volunteer Program
100 North Apache Rd. Suite D
Buckeye, AZ 85326
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