Santa Cruz — Click here for the printable .pdf Volunteer Program application.

Source: https://shf.santacruzcountyca.gov/Portals/1/County/sheriff/formsdocs/Volunteer%20Application%20and%20Waiver.pdf

Santa Cruz County Sheriff-Coroner Volunteer Application

Our Policy It is the policy of this organization to provide equal opportunities without regard to race, color, religion, national origin, gender, sexual preference, age, or disability.

Contact Information

Name Street Address City ST ZIP Code Home Phone Cell Phone E-Mail Address

Employment History

Current or Last Employer Position Length of Employment Supervisor Street Address City ST ZIP Code Phone E-Mail Address

Volunteer History

Organization Position Length of Service Supervisor/Coordinator Street Address City ST ZIP Code Phone E-Mail Address

Special Skills or Qualifications Summarize special skills and qualifications you have acquired from employment, previous volunteer work, or through other activities, including hobbies or sports .

Availability When days and times are you available for volunteer assignments?

Background Information

Date of Birth Drivers License or ID# List any adult arrest List any restraining orders List traffic citations <3 yrs. List any illegal drug use

Person to Notify in Case of Emergency

Name Street Address City ST ZIP Code Home Phone Cell Phone E-Mail Address

Agreement and Signature By submitting this application, I affirm that the facts set forth in it are true and complete. I understand that if I am accepted as a volunteer, any false statements, omissions, or other misrepresentations made by me on this application may result in my immediate dismissal.

Signature Date

Sheriff’s Office Use Only

Interview Drivers License Local Records State & Federal Warrants Employment Verification Volunteer Verification Live Scan Fingerprints

Approved:

Lieutenant Date

County of Santa Cruz

Sheriff-Coroner

5200 Soquel Ave., Santa Cruz, CA 95062 (831) 454-7610 (831) 454-7690

Jim Hart Sheriff-Coroner

Waiver and Release of Liability for All Applicants

I fully recognize that individuals must clearly demonstrate their personal, medical, and psychological fitness to serve with a law enforcement agency. I further recognize that an employing agency has both a legal and moral obligation to make every reasonable effort to insure that persons employed by them will conform to the highest standards.

I understand that an intensive investigation into all aspects of my background will be conducted. I also fully understand that all and any disqualifying information that is discovered or revealed by the Santa Cruz County Sheriff’s Office will be disclosed to my present employer (if present employer is a law enforcement related agency). I further recognize that although some of the information contained in this report is a matter of public record, or would otherwise be accessible to me, this information will be inextricably interwoven with other confidential data to which I would not be privy.

Therefore, I release and hold harmless the County of Santa Cruz, its Sheriff’s Office, and their officers, agents, or assigns, now and in the future, from any claims or damages, whether in law or equity, on behalf of myself, my heirs, agents, or assigns for their refusal to make available any and all information contained in this pre-employment investigation, including but not limited to the identity of any person or organization who may have supplied information in the course of this investigation, as well as the substance of any such information supplied.

I hereby knowingly, voluntarily, specifically, and permanently waive any rights I may have to examine, review, or to otherwise discover the contents of this investigation and all documents related thereto, whether by request, appeal, grievance, or by legal process.

This waiver and release of liability includes Deputy Sheriff and Trainee, Correctional Officer, Community Service Officer, Security Officer, Clerks, Cooks, and Volunteers.

Name Printed Date Signature

Santa Cruz County Sheriff’s Office

How did you learn of this volunteer opportunity?

Website Flyer Newspaper Recruiter Radio Sheriff’s Employee Sheriffs’ Volunteer Other

Civilian Volunteer

Personal History Questionnaire

Applicant: Position:

Phone: Email:

Address: City, St., Zip:

Date of birth: Drivers License #:

Computer Skills: Bi-Lingual/Language:

Other relevant skills or certifications:

For Departmental Use Only

Reviewed by: Title: Date:

Notes:

The Sheriff’s Office conducts a background investigation that includes fingerprinting, criminal history, drivers license, and employment/volunteer experience for all volunteer positions. All responses are subject to verification; any false statement, misrepresentation, or deliberately non-responsive answer will result in disqualification from the selection process for all positions with the Sheriff’s Office. It is in your best interests to answer all questions honestly, even if you feel there is something in your past that reflects poorly on you. The matter may or may not be disqualifying, but lying always results in disqualification. If you are dishonest during this process you will damage your future credibility with this agency and other law enforcement agencies. Read and answer each question carefully. Do not divulge information concerning a medical condition. If you have a question, ask a Sheriff’s representative.

Information that constitutes a prosecutable crime, possible endangerment to any person, or could

negatively reflect on your fitness for duty if currently employed by a public safety agency may be referred to the appropriate authority for investigation. If you do not want to complete this questionnaire you may withdraw from the selection process by informing a Sheriff’s representative.

By completing this questionnaire, I am acknowledging I have read and understand the above

information. I authorize investigation of all matters contained in this questionnaire. I agree to inform the Sheriff’s Office of any change of status that relates to the background investigation while involved in the selection process. I certify that all answers are true and accurate. I understand that any false statement or attempt to withhold information will result in my disqualification from the selection process.

Applicant Signature Date

1. Are you willing to respond to call-outs on evenings, nights, early mornings, weekdays, weekends, and holidays? (Not necessary for all volunteer positions)

Yes No - Explain:

2. Are you willing to work in adverse conditions including rain, wind, darkness, uneven terrain? (Not necessary for all volunteer positions)

Yes No - Explain:

3. Have you previously applied for any position with the Santa Cruz County Sheriff’s Office?

No Yes: Position: Year Result

4. Do you have a valid driver’s license?

Yes - State No

5. Has your driver’s license ever been suspended, revoked, or placed on probation?

No Yes Year: Reason:

6. Have you received any traffic citations during the past 3 years?

No Yes: Date/Offences: Date/Offences:

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7. Have you been involved as a driver in a motor vehicle accident during the past 3 years?

No Yes: Date and type of accident: At fault?: No/YES

8. Have you ever stole property from an employer?

No Yes/Year: Employer: Explain:

9. Have you ever been accused of sexual harassment or discrimination in the workplace?

No Yes/Year: Employer: Explain:

10. Do you have any bias, prejudice, or hatred against any persons or group of persons due to race, color, creed, ancestry, disability, medical condition, marital status, gender, pregnancy, sex, sexual orientation, age, or veteran status?

No Yes - Explain:

11. Have you ever used an illegal drug while you were working?

No Yes/Year: Employer:

12. Have you ever been involved in a physical altercation with a co-worker or supervisor?

No Yes/Year: Employer: Explain:

13. Have you ever served in the armed forces, National Guard, or military reserves?

No Yes/Branch of service Dates of service to Type of discharge

14. Have you ever been named in any restraining order, temporary restraining order, emergency protective order, domestic violence restraining order or court injunction?

No Yes/Year: County: Reason:

15. Have you ever been questioned as a suspect, accomplice, or accessory in any crime?

No Yes Year: Crime: Agency: Explain:

16. Have you ever been detained, handcuffed, cited, or arrested for any crime?

No Yes/Year: Crime: Agency: Explain:

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17. Have you ever been convicted or pled guilty or no contest to any crime?

No Yes/Year: Crime: Agency: Explain:

18. Has a warrant ever been issued for your arrest?

No Yes/Year: Crime: Agency: Reason:

19. Have you ever been placed on probation by any court or agency authorized to impose a term of probation or other type of supervision?

No Yes Year: Crime: Agency: Explain:

20. Have you ever been a member or associate of any criminal street gang?

No Yes Year: Gang: Moniker: Explain Affiliation:

21. Has anyone in your family ever been a member or associate of a gang or criminal enterprise?

No Yes Name: Relationship: Gang:

22. Have you ever been involved in a domestic dispute resulting in police response or investigation?

No Yes/Year: Agency: Reason: Explain Circumstances:

23. Have you ever been the subject of a referral to, or investigation by, any Child Protective Service agency or Adult Protective Service agency?

No Yes/Year: County: Explain Circumstances:

24. Have you ever used, consumed, tried, ingested, smoked, injected, etc. any the following drugs:

Cocaine or crack NO – YES Month and Year: Methamphetamine or other stimulants NO – YES Month and Year: Depressants NO – YES Month and Year: LSD, mushrooms, or other hallucinogens? NO – YES Month and Year: Heroin, opium or other narcotics? NO – YES Month and Year: Ecstasy or other designer drugs? NO – YES Month and Year: PCP? NO – YES Month and Year:

25. Have you ever sold or helped sell or distributed illegal drugs? NO – YES Month and Year:

Explain:

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