Emergency Operations Center Volunteer Form « Rochester Police Department

Name*

FirstLast

Date of Birth*

Applicants must be atleast 18 years or older to volunteer.

Contact Information

Address*

Street AddressAddress Line 2CityStateZip Code

Primary Phone*

Secondary Phone*

Email

Do you have any experience with radio, telecommunications, or any other skills that might be applicable?*

If yes, please explain*

Are you familiar with any of the social networking platforms listed below?

Check all that apply.

Have you ever been convicted of a crime?*

If yes, please explain.*

Background investigation*

I give the Village of Rochester permission to conduct a criminal background investigation to determine if I am an acceptable candidate.

Applicant's Electronic Signature*

PrefixFirstLastSuffix

By signing this form, I agree that the information provided above is truthful and has been filled out to the best of my ability.