In order to proceed in the application process, you must provide COMPLETE information, including your criminal history (if applicable) and all contact information for your references. In addition to this form all of the following documents are required prior to moving on to the next step for MCSO Records Clearance: MCSO Records Check Authorization, Release of Information (for accessing references), and 2011 Emergency Notification Contact.

Volunteer Information

First name:

Last name:

Middle name:

Street 1:

Street 2:

City:

State:

* Zip: *

Home phone:

* OK to call me here

Work phone:

OK to call me here

Cell phone:

Email address:

Date of birth:

US Citizen:

Social security number:

Please list ALL other names that you have used or been known as here.

Driver's License & Insurance Coverage Verification

Please provide the following information to document that you hold a valid driver’s license and auto insurance.

Driver's license number:

Insurance company:

Please note the policy holder's name if not yourself as well as the policy # and insurance agent's contact information.

Employment

Please list your last four (4) positions or a five (5) year employment history; list the most recent position first. Include your direct supervisor's name if different from Employer.

1

2

Employer name:

First name:

Last name:

Street 1:

Street 2:

Street 3:

City:

State:

Zip:

Work phone:

Email address:

3

4

Employer name:

First name:

Last name:

Street 1:

Street 2:

Street 3:

City:

State:

Zip:

Work phone:

Email address:

Please indicate your length of employment for each entry above.

Education

Education:

List all Colleges, Nursing, Military, Trade, Business, or other schools attended. Please include dates of attendance and attach a copy of your DD-214 if Military.

Criminal History

Have you ever been arrested or convicted of a crime? If yes, please list arrests, charges and/or convictions with the approximate dates and locations of occurrences.

COMPLETE information is required and failure to provide such may result in a denied application.

Supervised Release

Are you on any type of supervision such as probation (including unsupervised and/or bench probation), parole, pre-trial, or electronic monitoring? If yes, please list here.

Pending Cases

Do you have any pending court issues, including civil matters? If yes, please list here.

Driving Record

Has your driver’s license ever been suspended or revoked? If yes, please list date(s) and reason(s).

Personal References

Please list two (2) personal references you have known at least one (1) year and who are not related to you or living with you. No two (2) references will be accepted from the same address.

1

2

First name:

Last name:

Street 1:

Street 2:

City:

State:

Zip:

Home phone:

Work phone:

OK to call here

Work phone:

OK to call here

Cell phone:

Email address:

Relationship:

Volunteer Information Center

MCSO provides an online "Volunteer Information Center" where volunteers may check their schedules, update their information, and receive messages. Please select the password you would like to use to access MCSO VIC.

Please enter a password that:

Is between 6 and 30 characters long

Password:

Confirm password:

I Agree

I understand and agree that submitting this application form does not automatically register me as a Multnomah County Sheriff's Office volunteer.

I hereby swear or affirm that there are no willful misrepresentations, omissions, or falsifications of the preceding statements.

I authorize a criminal history and driving record check and an investigation of all statements made in this application. I understand that misrepresentation, falsifications, or omissions of facts in any documents I submit or statements I make as a part of this process, is cause for rejection of my application and/or termination of my Multnomah County Sheriff’s Office volunteer status.

I Agree