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Brighton Police Department Victim Services Volunteer Application

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First Name*
Last Name*
Address1*
Address2
City*
State*
Zip*
Home Telephone Number:
Cell Phone Number:
Work Phone Number:
Social Security #*
Date of Birth:*
Date of Birth:
Personal Information
Please Check Correct Response:
Physical Limitations:*
Education:
Highest Level Completed - Please Select Correct Response
Most Recent Employer:
List Previous Volunteer Experience:
Have you been asked to resign from any previous employment or volunteer position in the last 3 years?
(If Yes) Please Explain:
Do you have a valid Colorado Operator's License?
License #
Expiration Date:
Expiration Date:
Restrictions?
Have you ever had your driver's license suspended or revoked?
What type of vehicle insurance do you carry?
Policy #
Languages other than English (Fluent / Read / Write)
Volunteer Availability: (check all applicable):
Shifts are for 12 hours
1. 6:00am - 6:00pm Shift
1. 6:00pm - 6:00am Shift
1. No Preference
Days:
1. Sunday
2. Monday
1. Tuesday
2. Wednesday
1. Thursday
2. Friday
1. Saturday
In a case of an emergency, notify:
First Name
Last Name
Street Number
Street Name
Street Type
Apt #
City
State
Zip
Telephone
Have you ever been convicted of a misdemeanor or a felony?
Have you ever been charged or convicted of a charge of involving Domestic Violence?
Pleae mark all that apply to you in regards to your previous/current drug use:
1. Marijuana use in the last 5 years
2. Use Marijuana longer than 5 years ago
3. Other illegal drugs (not including LSD or Marijuana) longer than 5 years ago
4. LSD
5. Never used illigal drugs