Division______
Dallas Police Department Volunteer Application
PERSONAL
Name (Last, First, Middle)

Race / Sex

Street Address
Texas DL or ID Number

City,
SS Number (Last 4 digits)

Date of Birth
State

Business Phone

xxx-xx-

Zip
Home Phone

Cell

_________________

E-Mail Address (work and personal)
BACKGROUND
Please explain, briefly, why you wish to be a volunteer for the Dallas Police Department

Are there any skills would you like to utilize while volunteering?
What Volunteer Program (COPS, VIP, CHIPS, and VRT) are you interested in?

Circle Program

VIP-Neighborhood Association:

Have you had any moving violations in the last two years? (Volunteer Response Team only) If yes, explain (date, cited for)
Have you ever been arrested for, convicted of, or cited for an offense other than traffic violations? ____ yes ____ no. If yes, on a
separate sheet of paper explain in detail showing dates, charges, places, and actions taken.
EMPLOYMENT
Present Employer

Supervisor

Your Title

Address

Phone

Date Hired

Previous Employer

Supervisor

Your Title

Address

Phone

Date Hired

EMERGENCY CONTACT
Name

Relationship

Address

Home Phone

Work Phone

MEDICAL HISTORY
Medical information is needed in the event of an emergency. List any medications you are currently taking and the reason for
which they are used, and any other medical information you feel the Dallas Police Department should know. Attach a separate
sheet, if necessary.
CERTIFICATION and SIGNATURE
Please review you answers carefully and read the statements below before signing this application.

I hereby certify that there are no willful misrepresentations, omissions, or falsifications in the foregoing statements
and answers to questions. I understand that any omission or false statement on this application shall be sufficient
cause for rejection for enrollment or dismissal from the Dallas Police Department Volunteer Program. I understand
the purpose of the Volunteer Program is not to train citizens to be police officers and that all Volunteer Programs are
non-confrontational. I acknowledge that through my volunteer service I may be privileged to information that is not
available to the public and any release of that information may result in civil as well as criminal proceedings. I will
abide by all rules and regulations set forth by the Dallas Police Department. I give the Dallas Police Department and
its agents permission to conduct a thorough background investigation that may include, but not be limited to,
fingerprinting, any criminal history, employment history, and personal references.
Applicant’s Signature:

Mail to:
Dallas Police Department
NORTHWEST DIVISION
NEIGHBORHOOD POLICING UNIT
9801 HARRY HINES BLVD.
DALLAS, TEXAS 75220
(214) 670-6206

Date: