VOLUNTEER INTEREST FORM - Moreno Valley, California

1 VOLUNTEER INTEREST form Thank you for your INTEREST in joining the Moreno Valley Police Department s VOLUNTEER Forces Program. training for the program consists of 4-6 sessions (56 hours) held at the ben clark training center . Please complete this INTEREST form and return it to Moreno Valley Police Station, to the attention of the Community Services Unit. Upon our receipt of the completed application, you will be contacted for the next step in the hiring process. PLEASE PRINT OR TYPE: NAME: Last First Middle ADDRESS: Street City Zip Code HOME PHONE # WORK PHONE # DATE OF BIRTH _____ SOCIAL SECURITY # _____ DRIVER S LICENSE # STATE: E-MAIL: _____ PRIOR VOLUNTEER EXPERIENCE: All of the information contained on this form is to the best of my knowledge.

2 I understand that all information is subject to verification. Any intentional false statement will be grounds for disqualification from participating in this program. Signature of Applicant Date Moreno Valley Police Department 22820 Calle San Juan De Los Lagos Box 88005 Moreno Valley, Ca. 92552-0805 Telephone: (951) 486-6700 Fax: (951) 486-6750 Revised 12/16 : JW