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4. Thank you for your interest in volunteering for the Lino Lakes Department of Public Safety. Your application will be used to verify eligibility for a volunteer position with the Police Department. It is our policy to provide equal employment opportunities to all. Individuals are evaluated and selected solely on the basis of their qualifications. 

   Please furnish complete and accurate information so that we can properly evaluate your application. Be aware that the use of false or misleading information or the omission of important facts may be grounds for immediate dismissal. Also note that information you provide herein may be subject to later verification, background investigation and/or testing. You may attach to this application any additional information that helps explain your qualifications. (Please print clearly or type). The City of Lino Lakes considers applicants for all positions without regard to race, color, religion, sex, national origin, age, marital or veteran status, sexual preference, the presence of a non-job related medical condition or disability, or any other legally protected status. EOE/AA/ADA 

6. Volunteer Group Applying for:

   1. Reserve Unit
   2. CERT
   3. Internship/Service Learning
   4. Administration (Office Help/Investigations)
   5. Chaplin
   6. Public Safety Citizens Commission
8. Personal Information
10. First Name*
11. Last Name*
12. Middle Initial*
14. Address*
16. City*
17. State*
18. Zip Code*
20. Cell Number*
21. Home Number
22. Work Number
24. Email Address*
25. Are You 18 Years of Age or Older?*
    -- Select One --YesNo
27. What day(s) of the week and time are you available to volunteer?*
29. Briefly explain your interest in volunteering for the Police Department:*
33. Emergency Information

    In case of emergency, the person to contact should be:

35. Name*
37. Relationship*
39. Phone Number*
40. Alternate Phone Number
42. Address*
44. City *
45. State*
46. Zip Code*
50. Education and Training
52. High School*
54. Location*
55. Number of Years Completed*
57. Did You Graduate?*

    1. Yes
    2. No
61. College*
63. Course of Study*
65. Location*
66. Number of Years Completed*
68. Did You Graduate?*

    1. Yes
    2. No
69. Degree or Diploma?*

    1. Degree
    2. Diploma
73. Technical/Trade/Business*
75. Course of Study*
77. Location*
78. Number of Years Completed*
80. Did You Graduate?*

    1. Yes
    2. No
81. Degree or Diploma*

    1. Degree
    2. Diploma
85. Other Special Training or Skills

    Computer skills, GIS experience, etc. 

87. Work or Volunteer Experience

    Fill in information on your 2 most recent work or volunteer positions (you may exclude memberships which would reveal sex, race, religion, national origin, age, ancestry, sexual orientation, handicap or other protected status). You may also attach a resume. 

89. Attachment
91. Organization Name
92. Dates
    Dates Start Date

    —

    Dates End Date
94. Address
95. Telephone Number
97. List Your Duties/Responsibilities
101. Organization Name
102. Dates
     Dates Start Date

     —

     Dates End Date
104. Address
105. Telephone Number
107. List Your Duties/Responsibilities
109. References

     Please provide the name, address, and telephone number of three references who are not related to you and are not previous employers.

111. Name (Reference #1)*
112. Phone*
114. Address*
118. Name (Reference #2)*
119. Phone*
121. Address*
125. Name (Reference #3)*
126. Phone*
128. Address*
130. Conviction Information

     This question must be answered before your application will be considered.

     If the answer to this question is “Yes”, please attach a separate sheet of paper giving full particulars. This information will not be used to bar you from volunteering but may be used to direct your interest to areas less related to the area of your conviction. 

     You may answer “No” to this question if the conviction or records thereof have been annulled, sealed, set aside, or purged, or if you have been pardoned pursuant to law. 

132. During the past five years, have you served a sentence in a jail or prison or been convicted of a misdemeanor or felony for which a jail sentence could have been imposed?*

     1. Yes
     2. No
136. AUTHORIZATION FOR RELEASE OF INFORMATION

138. The Department of Public Safety, Police Department requires a check of the criminal history for all potential employees, volunteers, agents of the city, and independent contractors who have direct access to or management of public funds; substantial contact with juveniles in a setting where adults are not present; and/or access to confidential and private data. 

     The Department of Public Safety is offering to the undersigned, volunteer employment, subject to positive results of various investigations. Please complete the below required information authorizing the Lino Lakes Police Department to conduct the background check in the following areas: Criminal History Check, Local Police Record Check, Warrant Checks and Driver’s License Check. You will be informed of your status when your investigation is complete. The undersigned further release the City of Lino lakes and the State of Minnesota from any claims or damages which the undersigned might incur as a result of the police department obtaining this information from the State of Minnesota. 

     This information is being requested by the police department to determine whether the undersigned is disqualified from being a volunteer for the Lino Lakes Police Department. Under Minnesota State Law, the City can disqualify a person from employment because of a criminal conviction only if the conviction directly relates to the proposed job. This information is classified as private personnel data and will be provided only to those employees or agents who have a need to review it. The police department does not intend to release the information to any other party, but may be required to do so by subpoena or court order. The undersigned may refuse to authorize the release of this information, but refusal will result in disqualification as a volunteer. 

140. First name*
141. Middle Name*
142. Last Name*
144. Race*
145. Date of Birth*
     Date of Birth
146. Sex

     1. Male
     2. Female
148. Driver's License #*
149. State of Issuance*
151. Electronic Signature Agreement

     By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

     1. I agree.
153. Electronic Signature
155. Date*
     Date
157. Important Facts about Information on Your Application

159. In accordance with the Minnesota Government Data Practices Act, Minnesota Statute 13.04, Subd.2, the City of Lino Lakes is required to inform you of your rights as they pertain to private data you have provided. The following data is public information and accessible to anyone: veteran’s preference status, relevant test scores, rank on eligibility list, job history, education and training, and work availability. All other personal identifiable information is considered private, including but not limited to your name, home address and phone number. Private data is information, which is available to you, but not the public.

     1. I hereby certify that all statements herein are true and complete and authorize investigation of all information contained in this application. I understand that my present employer will not be contact for employment verification until I have become one of the finalists for the position for which I am applying. 

     2. Organizations and persons named herein are authorized to give information regarding me and they are hereby released from all liability for issuing such information. 

     3. I understand that misrepresentation or omission of facts called for herein will be sufficient cause for cancellation of consideration for volunteerism or dismissal if I have been accepted as a volunteer.

161. Electronic Signature Agreement

     By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

     1. I agree.
163. Electronic Signature
165. Date
     Date
Leave This Blank:


168. 1. Receive an email copy of this form.
169. Email address

     This field is not part of the form submission.

170. Submit

* indicates a required field