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:

* Zip: *

Primary phone:

Secondary phone:

Other phone:

Email address:

Date of birth:

Drivers License Class:

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:

Zip:

Primary phone:

Secondary phone:

Relationship:

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:

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.

Additional Languages

What languages, in addition to English do you speak and/or write.

Additional Languages:

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.

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.

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:

Last name:

Primary phone:

Relationship:

3

First name:

Last name:

Primary phone:

Relationship:

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