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2. 
3. 
5. Last Name*
6. First Name*
7. Middle Name
9. Address*
11. City*
12. State*
13. Zip*
15. How long at address?*
16. Phone*
18. Email Address*
19. Date of Birth*
    Date of Birth
21. Driver's License Number*
22. State*
24. Emergency Contact Name*
25. Phone*
27. QUESTIONNAIRE
29. Are you willing to commit to at least 8 hours a month to the VIPS program?*

    1. YES
    2. NO
31. Why are you interested in joining the Sachse VIPS program?*
33. EMPLOYMENT
35. I am currently:*

    1. Employed

    1. Unemployed

    1. Retired
37. If currently employed, please complete the following fields:
39. Name of Employer
41. Occupation
43. Address
44. Phone
46. City
47. State
48. Zip
50. PERSONAL REFERENCES
    You MUST provide three references
52. First Name*
53. Last Name*
55. Address*
56. Phone*
58. City*
59. State*
60. Zip*
64. First Name*
65. Last Name*
67. Address*
68. Phone*
70. City*
71. State*
72. Zip*
76. First Name*
77. Last Name*
79. Address*
80. Phone*
82. City*
83. State*
84. Zip*
86. PERSONAL DECLARATIONS
    All applicants will be subject to a criminal history check. Convictions or other criminal history may be relevant, but does not necessarily bar you from volunteering. If any questions is answered "YES" please include an explanation and include circumstances and dates where relevant.
88. Have you ever been arrested, charged with, or received deferred adjudication for a criminal offense for any reason?*

    1. YES
    2. NO
90. If YES, please explain
92. Are you presently under indictment or charged with a criminal offense, including DWI or DUI?*

    1. YES
    2. NO
94. If YES, please explain
96. Are you, or have you ever been on probation or parole?*

    1. YES
    2. NO
98. If YES, please explain
100. Has your driver's license ever been suspended, revoked, probated, or cancelled for any reason other than medical or disability reasons?*

     1. YES
     2. NO
102. If YES, please explain
104. Have you ever used marijuana or any other illegal drug?*

     1. YES
     2. NO
106. If YES, please include frequency and approximate time frames
108. Have you ever used any legal drug not prescribed by a physician?*

     1. YES
     2. NO
110. If YES, please include drug name, frequency, and approximate time frames
112. Have you sold, given, or delivered illegal drugs or narcotics to anyone?*

     1. YES
     2. NO
114. Have you ever been present when others used, bought, or sold illegal drugs?*

     1. YES
     2. NO
116. Are there any incidents (Positive or Negative) in your life or details not mentioned herein, which may influence this agency's evaluation of your application to volunteer?*

     1. YES
     2. NO
118. If YES, please explain
120. VOLUNTEERING INFORMATION
122. What skills do you have which you would want to provide as a volunteer?*
124. In what areas(s) of the Police Department are you interested in volunteering your services?*
126. Do you have any previous volunteering experience?*

     1. YES
     2. NO
128. If YES, when and where?
130. Approximate number of hours per month you are willing to volunteer.*
     -- Select One --89101112131415 or more
132. How did you hear about the VIPS program?*
134. By submitting this application, I hereby certify that there are not willful misrepresentations, omissions, for falsifications in the foregoing statements and answers to questions. I am fully aware that any willful misrepresentations, omissions, or falsifications may be grounds for immediate rejection of termination from participating in the Sachse Police Department VIPS program. I hereby release the Sachse Police Department from providing a reason for denial to the program.
136. Signature of Applicant*
     Please type your signature
137. Date*
     Date
Leave This Blank:


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

     This field is not part of the form submission.

141. Submit Submit and Print

* indicates a required field