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MONUMENT POLICE CADET EXPLORER PROGRAM EXPLORER POST 2010 Police Cadet Application Police Cadet Application – 06/13/07 i Thank you for your interest in the Monument Police Cadet Explorer Program. The Law Enforcement Exploring Post is designed for young men and women who live in or near the town of Monument, as a mentoring and training program for teens to become familiar with and involved in Law Enforcement; to further their knowledge and understanding of the criminal justice system through training; and to provide an insight into all phases of police work as a possible profession. The Cadet Program is a community service program; the Cadets participate in many community events throughout the year. While actively becoming a part of their community, the Cadets foster a better understanding between the Police Department and the youth of our Town. MISSION STATEMENT To promote and actively involve youth in the Monument Police Cadet Explorer Program by providing Law Enforcement training and insight in to all phases of the justice system; to foster personal development in leadership skills through Law Enforcement as a potential career; and to support an environment for understanding and teamwork between the Monument Police Department and young citizens. ---PAGE BREAK--- MONUMENT POLICE CADET EXPLORER PROGRAM EXPLORER POST 2010 Police Cadet Application Police Cadet Application – 06/13/07 ii Enclosed you will find an application, background packet, and a medical information form. It is a normal part of the Police Department procedure to perform checks (records and reference) on the suitability of new Cadets due to the sensitivity of the information with which you will be working. Included in the background packet is an in-processing form (used for the record check and setting up an I.D. card) and one reference check form that requires your signature. You do not need to send the reference check form out; we will take care of that. If there are questions at any time during the application process do not hesitate to call the Post Advisors at 481-3253. ALL QUESTIONS MUST BE ANSWERED COMPLETELY AND ACCURATELY. If a question does not apply enter N/A in the space provided. Falsification or failure to include information as directed will be considered grounds for non-acceptance or termination if already a member. Questions requiring additional information may be placed on the back of the form. A letter of recommendation from a professional, friend, neighbor, or an associate will aid in your acceptance into the Cadet Program. CADET PROGRAM REQUIREMENTS 1. MUST be between the ages of 14½ and 21. (Must apply prior to 20 th birthday) 2. MUST have and maintain a GPA of C or better. Must provide a copy of your report card 3. MUST pass a background investigation and an oral board interview 4. MUST be able to attend 70% of all sessions. Must complete a 6 month probationary period. 5. MUST be willing and able to participate in meetings scheduled every other week, special police training, community service events, post fundraising activities, and some social activities. 6. MUST have parent’s permission to ride along with Patrol Officers. 7. MUST join Learning for Life Explorer Post 2010 (includes girls). 8. Applicants will be notified upon acceptance. All new Cadets will undergo a probation trial period. You must purchase the probationary uniform consisting of a plain white polo shirt or blouse and black slacks that are required during this time. The Cadet patch will be provided to you. 9. At the end the probationary period, new Cadets will receive the Cadet uniform. All interested persons should contact 481-3253 or mail applications to: Monument Police Department Attn: Explorer Post 2010 P.O. Box 325 Monument, CO 80132 ---PAGE BREAK--- MONUMENT POLICE CADET EXPLORER PROGRAM EXPLORER POST 2010 Police Cadet Application Police Cadet Application – 06/13/07 iii TO HELP ALL APPLICANT’S FILL OUT THE BACKGROUND CHECK FORMS, USE THE FOLLOWING INSTRUCTIONS 1. For the Background check release form (Page 6) a. Print your name and date of birth on all 4 top lines b. Date all 4 releases c. Sign all 4 releases and, if you are under 18, have a parent’s/guardian’s signature 2. For the reference check letter form (Page 7 ) a. Print your name at the top of the from b. Sign the Applicant’s Signature line (if you are under 18 you must have a parent’s/ guardian’s signature) c. Print the name and address of whom the form is going to d. This form will go to the person you have listed as a reference on your application 3. The Monument Police Department In-processing form (Page 8, 9, &10) a. Fill in the top personal information square at the top of page 10 b. Fill in this top square completely and as accurately as possible c. Print your name and your signature in the applicant’s line in the “I agree to the following terms” box on page 10 (Keep these pages for your own records) ---PAGE BREAK--- MONUMENT POLICE CADET EXPLORER PROGRAM EXPLORER POST 2010 Police Cadet Application Police Cadet Application – 06/13/07 1 of 12 Date of Application NAME: Date of Birth: Age: (Last) (First) (Middle) Address: (Number) (Street) (City) (State) (Zip) Home Phone: Work Phone: E-Mail Address: Other Phone: Sex: Race: Place of Birth: Citizenship: HT: WT: Hair: Eyes: SSN: Please state how you found out about the program: SCHOOL INFORMATION School: Year: GPA: (CURRENT OR LAST SCHOOL ATTENDED) Counselor: Phone Number: EMPLOYMENT INFORMATION Employer: Phone Number: (List business name and current supervisor) Address: (Number) (Street) (City) (State) (Zip) PERSONAL REFERENCE List one personal reference (OTHER THAN A RELATIVE) and state your relationship to them. Name: Phone Number: Address: Relationship: ---PAGE BREAK--- MONUMENT POLICE CADET EXPLORER PROGRAM EXPLORER POST 2010 Police Cadet Application Police Cadet Application – 06/13/07 2 of 12 PARENT(s)/GUARDIAN INFORMATION Which parent/guardian do you live with? (Circle one) MOTHER FATHER BOTH GUARDIAN Mother’s Name: Day Time Phone: Address: E-Mail Address: Alternate Phone: Father’s Name: Day Time Phone: Address: E-Mail Address: Alternate Phone: Guardian’s Name: Day Time Phone: Address: E-Mail Address: Alternate Phone: The information in this packet is accurate to the best of my knowledge: (Applicant’s signature) This information has been reviewed and verified by: (Parent’s/Guardian’s signature required if under 18 yrs of age) (IF UNDER 18 PROVIDE A LETTER FROM YOUR PARENT(S) STATING HOW THEY WILL BACK AND SUPPORT YOU IN THIS PROGRAM) ---PAGE BREAK--- MONUMENT POLICE CADET EXPLORER PROGRAM EXPLORER POST 2010 Police Cadet Application Police Cadet Application – 06/13/07 3 of 12 BACKGROUND INFORMATION PERSONAL INFORMATION Name of Applicant: Do you possess a valid Driver’s License? (If yes, complete the following.) State: Number: Type: Expiration: Has your license ever been Suspended or Revoked? (If yes, complete the following.) Date: Reason: Do you own a vehicle? Year: Make: Model: Vehicle License Number: Vehicle License State: List all traffic tickets you have received (use back of page if necessary.) Month/Year Charge Location Disposition Have you ever been involved in a traffic accident (AS A DRIVER)? If yes, give all date and locations: Have you ever been Suspended or Expelled from school? If yes, explain: ---PAGE BREAK--- MONUMENT POLICE CADET EXPLORER PROGRAM EXPLORER POST 2010 Police Cadet Application Police Cadet Application – 06/13/07 4 of 12 BACKGROUND INFORMATION Continued HAVE YOU EVER BEEN CHARGED WITH A CRIME? If yes, please complete the following (list juvenile as well as adult records) - list any additional information on the back OFFENSE CITY DATE DISPOSITION If you are under the age of 21, do you consume alcoholic beverages? If yes, explain: GENERAL INFORMATION If you are under the age of 18, do you use tobacco? If yes, explain? Why do you want to become a Cadet? If accepted for this program, what will be your goals? ---PAGE BREAK--- MONUMENT POLICE CADET EXPLORER PROGRAM EXPLORER POST 2010 Police Cadet Application Police Cadet Application – 06/13/07 5 of 12 BACKGROUND INFORMATION Continued Are you willing and able to attend the regularly scheduled meetings every month? Are you willing and able to participate in community service projects? List any community service organizations, social, school, or other groups that you are now a part of or have been a member of: List any courses or training you feel would have an effect on the Cadet Program: (COPIES OF TRAINING CERTIFICATES CAN BE SUBMITTED WITH APPLICATION) The information in this packet is accurate to the best of my knowledge: (Applicant’s signature) This information has been reviewed and verified by: (Parent’s/Guardian’s signature required if under 18 yrs of age) (Once submitted, all applications become property of the M.P.D.) ---PAGE BREAK--- MONUMENT POLICE CADET EXPLORER PROGRAM EXPLORER POST 2010 Police Cadet Application Police Cadet Application – 06/13/07 6 of 12 Background Check Release Forms I, (your name) , Date of Birth do hereby authorize the Town of Monument Police Department designee, and or Post Advisor to have access to any records your agency may have concerning me. Date: (Signature) (Parent’s/ Guardian’s signature if applicant is under 18) I, (your name) , Date of Birth do hereby authorize the Town of Monument Police Department designee, and or Post Advisor to have access to any records your agency may have concerning me. Date: (Signature) (Parent’s/ Guardian’s signature if applicant is under 18) I, (your name) , Date of Birth do hereby authorize the Town of Monument Police Department designee, and or Post Advisor to have access to any records your agency may have concerning me. Date: (Signature) (Parent’s/ Guardian’s signature if applicant is under 18) I, (your name) , Date of Birth do hereby authorize the Town of Monument Police Department designee, and or Post Advisor to have access to any records your agency may have concerning me. Date: (Signature) (Parent’s/ Guardian’s signature if applicant is under 18) ---PAGE BREAK--- MONUMENT POLICE CADET EXPLORER PROGRAM EXPLORER POST 2010 Police Cadet Application Police Cadet Application – 06/13/07 7 of 12 CADET REFERENCE CHECK Cadet Applicant’s Name (Please Print): I have applied to become a Cadet with the Monument Police Department and have given your name as a reference. I request and authorize you to furnish the Monument Police Department with the requested information listed below. This information will be used in determining my qualification and fitness for the Monument Police Cadet Explorer Program. I hereby release you from any liability or damages that may result from furnishing such information. Applicant’s Signature Date Parent’s/Guardian’s Signature if under 18 Date Reference Name: Reference mailing address: City State Zip Code Please answer the following questions, sign and return this form in the enclosed envelope. (Envelope not provided if obtained by the applicant via the internet online.) The applicant has signed the above Release of Information. The information you give will remain confidential. Your promptness in returning this form to the address above will expedite the process for the applicant to become a Cadet with the Monument Police Department. 1. How do you know the applicant? ( ) Friend ( ) Co-Worker ( ) Relative ( )Employer ( ) Acquaintance ( ) School personnel ( ) Other (Describe) 2. Approximately how long have you known the applicant? 3. What are the person’s best qualities? 4. What are potential areas of improvement for the applicant? 5. Do you know of anything that might preclude the applicant from working with a law enforcement agency? ( ) Yes ( ) No If yes, please explain 6. Would you recommend the applicant as a Cadet with the Monument Police Department? ( ) Yes ( ) No Indicate why or why not Reference’s Signature Date TO BE COMPLETED BY REFERENCE After completion, please return to: Monument Police Department Attn: Explorer Post 2010 P.O. Box 325 Monument, CO 80132 ---PAGE BREAK--- MONUMENT POLICE CADET EXPLORER PROGRAM EXPLORER POST 2010 Police Cadet Application Police Cadet Application – 06/13/07 8 of 12 MONUMENT POLICE DEPARTMENT IN-PROCESSING FORM Welcome to the Monument Police Cadet Explorer Program. As part of the processing for your Access or ID card, the following information is needed: Complete only the information in the top box below NAME: AKA Last First MI Maiden/Any Other Names Ever Used HOME Street City State Zip MAILING (If different) Street City State Zip HOME PHONE: WORK PHONE: CELL PHONE: DRIVER’S LICENSE STATE: EXP DATE: RACE: EYES: HAIR: SEX: PLACE OF BIRTH: HEIGHT: DATE OF BIRTH: WEIGHT: SOCIAL SECURITY Below this line for Internal Police Department use only CHOOSE APPROPRIATE CATEGORY Department Sworn Retired Sworn Outside Sworn Law Enforcement Agency Date (if Civilian: Regular Temporary Special X Volunteer: Chaplain X Cadet Other Contractor Company Outside Civilian Agency Date (if ACCESS CARD REQUESTED X ID CARD REQUESTED ID JOB TITLE: CADET UNIT(S) ASSIGNED: DEPT ASSIGNED: CARD KEY APPROVED BY: DATE: Records and ID Section use only IF “YES” IN ANY CATEGORY, ATTACH COPY OF WANTS/WARRANTS AND HISTORY WANTS/WARRANTS CRIMINAL HISTORY CHECK LOCAL YES/NO FOR: □ CRIMINAL □ EMPLOYMENT NCIC/CCIC YES/NO NCIC/CCIC CRIMINAL HISTORY? YES/NO CJIS/CRIMINAL RECORD YES/NO CJIS/TRAFFIC RECORD YES/NO TERMINAL OPERATOR COLO TRAFFIC RECORD YES/NO REQUESTED IBM Telephone FINGERPRINTED: FINGERPRINTED FOR OSN: YES/NO PLEASE RETURN FORM TO POST ADVISORS ---PAGE BREAK--- MONUMENT POLICE CADET EXPLORER PROGRAM EXPLORER POST 2010 Police Cadet Application Police Cadet Application – 06/13/07 9 of 12 MONUMENT POLICE DEPARTMENT ISSUED EQUIPMENT ITEM NUMBER DATE ISSUED ISSUED BY APPLICANT SIGNATURE ID CARD ACCESS CARD BADGE UNIFORM PANTS UNIFORM SHIRT UNIFORM PATCHES INSIGNIA OTHER (SPECIFY) MONUMENT POLICE DEPARTMENT RETURNED/VOIDED EQUIPMENT ITEM NUMBER DATE RETURNED/ VOIDED RECEIVED BY ADVISOR SIGNATURE ID CARD ACCESS CARD BADGE UNIFORM PANTS UNIFORM SHIRT UNIFORM PATCHES INSIGNIA OTHER (SPECIFY) ---PAGE BREAK--- MONUMENT POLICE CADET EXPLORER PROGRAM EXPLORER POST 2010 Police Cadet Application Police Cadet Application – 06/13/07 10 of 12 I agree to the following terms: 1. Upon termination of volunteer service with the Monument Police Department, applicant will immediately return all issued equipment to the Post Advisors (Monument Police Department, 154 North Washington Street, Monument, CO 80132, Telephone Number 481-3253). 2. Loss of issued equipment will immediately be reported to the Post Advisors (Monument Police Department, 154 North Washington Street, Monument, CO 80132, Telephone Number 481-3253). 3. The cost for a replacement access card key or identification card that is not returned as stated above is $15.00. The agency of the employee is responsible for the return of the card or payment if the card is lost/not returned. 4. Applicant agrees to immediately surrender the all issued equipment upon request from the Chief of Police (or his designee). 5. Applicant will use the issued equipment for official business only and will not allow any other person to use the equipment. Applicant Please Print Applicant Signature: Applicant’s Agency Head (or ---PAGE BREAK--- MONUMENT POLICE CADET EXPLORER PROGRAM EXPLORER POST 2010 Police Cadet Application Police Cadet Application – 06/13/07 11 of 12 HEALTH HISTORY INFORMATION This information is optional but will assist the program in insuring the safety of all involved. The information in this packet is accurate to the best of my knowledge (Applicant’s signature) This information has been reviewed and verified by (Parent’s/Guardian’s signature required if under 18 yrs of age) the parent/guardian of (Applicant’s name) This line should ONLY be completed if the applicant or parent/guardian refused to complete the health history information form Refused to provide information (Applicant’s signature or signature of parent’s/guardian’s if under 18 yrs of age) Are you allergic to any medications? YES / NO If yes, list and explain: Do you have any illness or condition that may prevent you from taking part in Cadet Activities? YES/NO If yes, explain: Are you taking any medications on a regular basis YES / NO If yes, please list medication and dosage Do you wear glasses/contact lenses? YES / NO Vision without correction: Do you have any hearing impairments? YES / NO If yes, explain: Have you ever been diagnosed with a mental or nervous disorder? YES / NO If yes, explain: ---PAGE BREAK--- MONUMENT POLICE CADET EXPLORER PROGRAM EXPLORER POST 2010 Police Cadet Application Police Cadet Application – 06/13/07 12 of 12 HEALTH HISTORY INFORMATION Continued Do you have or have you ever had the following: Asthma Diabetes Fainting Spells Heart Trouble Convulsions Bleeding Disorders Allergies Any conditions that may require special care, medication, or diet If yes to any of the above, explain: Do you have any restriction of activity for medical reasons? YES / NO If yes, explain: Thank you for your application