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MARYSVILLE CRIME PREVENTION VOLUNTEER APPLICATION (All Volunteers must reside within the City of Marysville) PLEASE PRINT FULL NAME DATE OF BIRTH ADDRESS HOME PHONE CELL PHONE EMAIL ADDRESS EMERGENCY CONTACT PERSON EMERGENCY CONTACT PHONE NUMBER EDUCATION: HIGH SCHOOL ( ) COLLEGE ( ) AREA OF STUDY: OTHER SCHOOLING OR TRAINING PREVIOUS OCCUPATION(S) INTERESTS/HOBBIES OTHER VOLUNTEER WORK YOU HAVE DONE HAVE YOU EVER BEEN CONVICTED OF A FELONY? YES ( ) NO ( ) IF YES, PLEASE EXPLAIN HOW MANY HOURS A WEEK ARE YOU AVAILABLE? WHO/WHAT PROMPTED YOU TO VOLUNTEER? REFERENCES (FULL NAMES AND ADDRESSES REQUIRED) 1. 2. SIGNATURE DATE *BY MY SIGNATURE, I AUTHORIZE THE MARYSVILLE POLICE DEPARTMENT TO DO A BACKGROUND CHECK Of MY DRIVING RECORD AND MY CRIMINAL RECORD. FOR OFFICIAL USE ONLY BACKGROUND CHECK COMPLETED DATE REVIEWED BY COORDINATOR DATE REVIEWED BY COMMANDER DATE CLEARANCE GRANTED BY ( ) NCIC ( ) LOCAL ( ) LOCAL