Police Department Volunteer Force Application
Please complete this application form if you are interested in serving as a City of Roseville Police Reserve officer.
1. Review the application first to make sure you have all the required information available before you start.
2. Fill out the application completely as you cannot return to the form to complete it later.
3. When complete, click the "Continue" button at the bottom.
Information collected is being transmitted via a secure connection using SSL and will only be used to process your application.
Contact Information
First name:
*
Last name:
*
Middle name:
Nickname:
Street 1:
*
Street 2:
City:
*
State:
Choose
AK
AL
AR
AZ
CA
CO
CT
DC
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
MS
MT
NC
ND
NE
NH
NJ
NM
NV
NY
OH
OK
OR
PA
PR
RI
SC
SD
TN
TX
UT
VA
VT
WA
WI
WV
WY
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Zip:
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Primary phone:
*
Secondary phone:
Other phone:
Email address:
*
Date of birth:
Month
Jan
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Day
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1917
*
Drivers License Class:
Choose
Class A
Class B
Class C
Class D
Class E
Drivers License #:
Emergency Contact
Please list the name and phone number for the person we should contact in case of an emergency. If you are a minor, this needs to be a parent or guardian.
First name:
*
Last name:
*
Street 1:
City:
State:
Choose
AK
AL
AR
AZ
CA
CO
CT
DC
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
MS
MT
NC
ND
NE
NH
NJ
NM
NV
NY
OH
OK
OR
PA
PR
RI
SC
SD
TN
TX
UT
VA
VT
WA
WI
WV
WY
Zip:
Primary phone:
*
Secondary phone:
Relationship:
Choose
Co-worker
Daughter
Father
Friend
Guardian
Mother
Neighbor
Other
Son
Spouse/Partner
Supervisor
*
Employment & Law Enforcement Experience
Please list your current or most recent employer(s). Please list all previous Law Enforcement experience.
Employer:
Job Title:
Please list previous employers, positions and fields worked in:
Education
Education:
Choose
Associate Degree
Bachelors Degree
Doctoral Degree
High School
Masters Degree
Post Grad/Professional
Professional Degree/Cerificate
Some College
Some High School
Trade/Vocational School
School:
Please provide additional relevant information regarding certificates, degrees, or schools attended:
Skills & Interests
In which of the skills listed below do you feel you have moderate to excellent skill? Check all that apply. Please indicate any and all Parks you would be interested in assisting with.
Skills/Interest:
Citizen Park Patrol
Donation Procurement
Grounds Maintenance
Natural Habitat Restoration
Office Support
Park Beautification/Gardening
Photography
Police Reserves
Public Speaking
Reception
Special Events
Sports
Traffic Control
Volunteer Management
Working with kids
Writing
Please tell us why you are interested in volunteering with the City of Roseville. If you are looking for class credit, please indicate what class requirements we can assist with.
Additional Languages
What languages, in addition to English do you speak and/or write.
Additional Languages:
American Sign Language
Hmong
Karen
OTHER
Somali
Spanish
Thai
Please list any "OTHER" languages here. Please describe your fluency in each language.
Availability
Please indicate the days, times and approximate number of hours you are usually available to serve.
Sun
Mon
Tue
Wed
Thu
Fri
Sat
Morning:
Afternoon:
Evening:
My availability is:
Choose
on-call
one time
Ongoing
Ongoing, except between these dates
Only between these dates
project/event based
short-term
with a group
with my family/child(ren)
with my spouse
From:
Month
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Day
1
2
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5
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31
Year
2022
2023
2024
2025
2026
2027
2028
2029
2030
2031
2032
to:
Month
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Day
1
2
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5
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29
30
31
Year
2022
2023
2024
2025
2026
2027
2028
2029
2030
2031
2032
Number of hours:
Frequency:
Choose
Monthly
Total
Weekly
If you are applying for a particular volunteer position, please specify.
Demographics
You may optionally provide the following information. It is used only to help us get a better idea of the demographic make-up of our Police Reserve Unit. Only City of Roseville Volunteer Services and Police Reserve Staff will view this information.
Gender:
Choose
Choose not to self-identify
Female
Male
Non-Binary
Other
Transgender
Race:
Choose
American Indian/Alaska Native
Asian
Black/African American
Hispanic or Latino
Native Hawaiian or Pacific Islander
Other Race/Ethnicity
Two or More Races
White/Caucasian
How did you hear about us?:
Cable Channel 16
City Newsletter
City Staff/Volunteer
City Website
Facebook
Family Member
Flyer
Hands On Twin Cities
Nextdoor.com
Other
Parks and Rec Activities Guide
Roseville City News
Roseville Review
Twitter
Volunteer Match.com
References
All applicants must provide three references you have known for at least one year, who can attest to your work habits and experiences.
1
2
First name:
First name:
Last name:
Last name:
Primary phone:
Primary phone:
Relationship:
Choose
Co-worker
Daughter
Father
Friend
Guardian
Mother
Neighbor
Other
Son
Spouse/Partner
Supervisor
Relationship:
Choose
Co-worker
Daughter
Father
Friend
Guardian
Mother
Neighbor
Other
Son
Spouse/Partner
Supervisor
3
First name:
Last name:
Primary phone:
Relationship:
Choose
Co-worker
Daughter
Father
Friend
Guardian
Mother
Neighbor
Other
Son
Spouse/Partner
Supervisor
I Agree
I certify that the facts set forth in the Police Reserves application are true to the best of my knowledge. I understand that any falsification, misrepresentation or concealment of information on this application may be sufficient grounds for disqualification for serving or immediate discharge and that the City of Roseville shall not be liable in any respect if my service is so denied or terminated. I understand that this completed application is the property of City of Roseville and will not be returned. I understand that I must notify the Volunteer Coordinator of any changes in my name, address, or phone number. I understand that I am applying for a volunteer position and that I will not be paid in any way. I understand that a background check and/or reference checks may be required for certain volunteer positions.
Volunteers are responsible for maintaining the confidentiality of all non-public information to which they are exposed while serving as a volunteer. Failure to maintain confidentiality may result in termination of the volunteer's relationship with the City or other corrective action.
DATA PRIVACY NOTICE
Minnesota law requires that you be informed of the purposes and intended uses of the information you provide to the City of Roseville during the application process or during volunteer assignments. Any information about yourself that you provide during the application and interview process will be used to distinguish you from other applicants and identify you in our program records; as well as enabling us to contact you. The following information which you will be asked to provide in this application process is considered private data: name, address, home phone number, gender and age. Private data is available only to you and to other persons at the City of Roseville who have a bona fide need for that data. Public data is available to anyone requesting it and consists of all data furnished in the application process, which is not designated in this notice as private data. Please note that the City does not share information gathered through its sites with third parties for promotional purposes.
Although you are not legally required to supply information, if you do not supply the information requested, it may mean that your application is not considered.
If I am selected as a volunteer for the City of Roseville, I give my permission for photo/video footage taken of me working as a volunteer to be used by the City of Roseville for marketing purposes.
I Agree
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