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Volunteer Personnel Application Packet
Pembroke Pines Police Department

***Potential volunteers must complete our PPPD Citizen's Police Academy Program prior to applying unless you are volunteering for our Animal Assistance Program***
Name (first, middle, last)*
Current Address*
City and State*
Zip Code*
Home Phone
Cell Phone
Date of Birth*
Age
Sex / Gender
Drivers License #
State
Exp. Date
Email Address*
Emergency Contact & Medical Information:
Name
Relationship to You
Phone Number / Contact Information
Are you willing to provide a medical release by your personal physician prior to your approval and acceptance?
1. Yes
1. No
If no to the above, why?
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Volunteer Areas:
What areas are you interested in working within the department?
1. Clerical
2. Animal Assistance Program
3. Front Desk
4. Fingerprinting
Are you willing to transfer within the department as the need arises?
1. Yes
1. No
What hours are you available?*
What days are you available?*
Please list any other information or requests that we should know:
Please complete the following sentence:
I want to become a Pembroke Pines Police Department volunteer because...
References:
Name
Occupation
Telephone Number
Relationship to You
Years Known
Address
City
State
Zip Code
Name
Occupation
Telephone Number
Relationship to You
Years Known
Address
City
State
Zip Code
Name
Occupation
Telephone Number
Relationship to You
Years Known
Address
City
State
Zip
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Have you ever worked for the City of Pembroke Pines?*
1. Yes
1. No
If yes to above, please give the dates of employment and the division you worked under:
Are you related to any city employee, or is any member of your household employed by the City?*
1. Yes
1. No
If yes to above, please give the person's name:
Relationship to You
Division They Work In:
Other than minor traffic offenses, have you ever been arrested or convicted of a crime?*
1. Yes
1. No
If yes to above, please explain:
I have read and understand the above application. I further understand that this is not an application for employment and do not expect payment or reimbursement from the City of Pembroke Pines for the services and time volunteered to the Police Department.
As an applicant for a volunteer position with the Pembroke Pines Police Department, I am required to furnish information concerning my moral, physical, educational and mental qualifications. In this regard, I hereby authorize inquiries regarding the above qualifications. Additionally, I authorize those individuals or organizations selected by the Pembroke Pines Police Department to release any and all information they have concerning me, including information of a confidential or privileged nature.
The Pembroke Pines Police Department reserves the right to accept the most qualified volunteers. Any decision by the Pembroke Pines Police Department regarding the qualification of any applicant for the Volunteer Program will be final and no employer or agent of the City of Pembroke Pines is required to render an opinion or explanation beyond what is contained in the public record.
I have read and understand the above.
Applicant Name*
Date*
Application received by:
Time and Date

Leave This Blank:

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

This field is not part of the form submission.
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Volunteer Personnel Application Packet

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Volunteer Personnel Application Packet
Pembroke Pines Police Department

Emergency Contact & Medical Information:

2

Education:

Employment Experience / Skills:

Military Experience or Specialized Training:

Foreign Languages:

3

Volunteer Areas:

Please complete the following sentence:

References:

4

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Volunteer Personnel Application Packet

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Volunteer Personnel Application PacketPembroke Pines Police Department

Emergency Contact & Medical Information:

2

Education:

Employment Experience / Skills:

Military Experience or Specialized Training:

Foreign Languages:

3

Volunteer Areas:

Please complete the following sentence:

References:

4

Volunteer Personnel Application Packet
Pembroke Pines Police Department