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Brighton Police Department Victim Services Volunteer Application First Name Last Name Telephone Social Security # Date of Birth Personal Information (please check correct response): Physical Limitations: No ___Yes (Please Education (highest level completed) please check correct response Grades 1-12 __GED ___College ___Graduate School Technical/Vocational 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? No ___Yes (Please Explain) Do you have a valid Colorado Operator’s License? License Restrictions…….………….Have you ever had your driver’s license suspended or What type of vehicle insurance do you Languages other than English Fluent Read Write 1 2 Volunteer availability: (check all applicable) Shifts are for 12 hours 6:00am – 6:00pm Shift 6:00pm – 600am Shift No Preference __Sunday __Monday __Tuesday __Wednesday __Thursday __Friday __Saturday No Preference In a case of an emergency, notify: First Name Last Name Address City/State/Zip. Have you ever been convicted of a misdemeanor or a felony? Yes___ No___ Have you ever been charged or convicted of a charge involving Domestic Violence? Yes___ No___ Please mark all that apply to you in regards to your previous/current drug use: ___Marijuana use in the last 5 years ___Use marijuana longer than 5 years ago ___Other illegal drugs (not including LSD or Marijuana) longer than 5 years ago ___LSD ___Never used any illegal drugs