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Step One

Volunteers in Policing (ViP) Program Application
The Woodland Police Department appreciates your interest in the Volunteers in Policing Program. Since volunteers often work with police reports or other confidential documents, all applicants are required to complete the enclosed background and application forms. This will assist the Woodland Police Department in determining your suitability for the Volunteers in Policing program. The information you provide in the enclosed packet will be used in the investigation of your background in the program and will be kept confidential. After you have submitted your completed packet the information will be referred to the coordinator for verification. Providing you meet the background standards, the coordinator will attempt to match you based on availability, skills, abilities, and interests, as indicated on your application.
Please complete the packet thoroughly and accurately. Keep in mind:
1. The completion of all these forms is mandatory. 2. All statements are subject to verification. 3. Deliberate inaccuracies or incomplete statements may bar or remove you from acceptance and/or participating.
Honesty Advisement*
It is to your advantage to respond openly. Any negative factor in your background will be evaluated in terms of the circumstances and facts surrounding its occurrence. For example, being fired from a job or having an arrest record is not in itself grounds for disqualification. During the investigation, the investigator will inquire into the facts surrounding such an occurrence. An evaluation will then be made of the relevance of these facts to the requirements of the job.
1. I understand.
REQUIRED DOCUMENTS
Please take a minute to prepare your digital documents. You will not be able to complete and submit this application without them. You will need to locate and scan the following documents in order to proceed with this online application. All documents submitted shall become a permanent entry as part of your application for the Volunteers in Policing Program.
Required Documents for Application*
Please check off the required documents once you have them scanned and ready to attach:
1. California Driver's License or ID Card
2. Valid Auto Insurance
3. Clearance from Medical Doctor
Social Security Card*
You will be required to provide the Volunteer Coordinator with a photocopy of your social security card in person at a later date during the application process. We are not requesting it be sent digitally to ensure property security measures. Do you have your original or photocopy of your social security card in your possession?
1. Yes
1. No
Requirement of Live Scan Fingerprinting*
Once you turn in the above listed forms along with the following application, it will be reviewed. If you pass the initial application phase, our Volunteer Coordinator, will contact you to schedule a LiveScan appointment for a Department of Justice fingerprint check. YOU DO NOT SCHEDULE YOUR OWN FINGERPRINT APPOINTMENT – WE WILL FACILITATE THE SCHEDULING. We will contact you to schedule you fingerprint appointment.
1. I understand.
APPLICATION
First Name*
Middle Name
Last Name*
AKA / Nickname / Alias / Maiden Name
Other Names Previously Used
Date of Birth
Date of Birth
Physical Address*
City*
State*
Zip Code*
Mailing Address (If different than above)
City
State
Zip Code
Home Phone Number*
Cell Phone Number*
Work Phone Number
Email Address*
Driver's License / ID Card Number*
Gender*
Race
Place of Birth*
Height*
EX: 5' 6"
Weight*
EX: 180
Hair Color*
Eye Color*
List any languages beside English that you speak fluently:*
If none, please put N/A.
Division / Section you are interested in working (if known):*
If unknown, please list N/A.
Skills*
List any skills (i.e., typing, public speaking, telephones) you possess that would help us to place you in an appropriate volunteer position. If typing is listed, please indicate net words per minute:
Computer Experience*
List computer software programs where you have experience:
Availability to Volunteer
Please complete all that apply:
Sunday
Sunday Start Time
—
Sunday End Time
Monday
Monday Start Time
—
Monday End Time
Tuesday
Tuesday Start Time
—
Tuesday End Time
Wednesday
Wednesday Start Time
—
Wednesday End Time
Thursday
Thursday Start Time
—
Thursday End Time
Friday
Friday Start Time
—
Friday End Time
Saturday
Saturday Start Time
—
Saturday End Time
Comments about Availability
Driver's License/ ID Card Upload
**REQUIRED** Please upload a clear scan of your Driver's License or ID Card.
DMV Driver's Record (3 year history)
**REQUIRED** Please upload a PDF of your DMV Driving Record. NOTE: You can request and receive a copy online at www.dmv.ca.gov. The cost is minimal.
REQUIRED DOCUMENTS (UPLOADS)
If you are having issues with uploading documents, please contact our Volunteer Coordinator, Vanessa McKenzie, at Vanessa.Mckenzie@cityofwoodland.gov or 530-661-7875.
Vehicle Information
Please list the year, make, model and color of your personal vehicle.
Proof of Auto Insurance
**REQUIRED** Please upload a PDF of your current auto insurance.
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Health Information

PERSONAL PHYSICIAN FITNESS RELEASE FORM
It is the desire of the Woodland Police Department to have volunteers that are medically fit and able to perform the different duties that volunteers will be asked to do. Therefore, it is required that the volunteer applicant set an appointment with their personal physician to be examined and be declared physically qualified to serve as a volunteer for the Woodland Police Department.
Fitness Release Form Upload*
Please upload the completed Personal Physical Fitness Release Form. Make sure it is signed and dated by your physician.
Physical Markings*
Please select all that apply:
1. Tattoos (T)
2. Scars (S)
3. Marks (M)
1. Physical Characteristics (P)
2. None
If yes, please list location and description
List any physical conditions or limitations you may have that pertains to your participation with the Volunteers in Policing Program*
If none, please list N/A.
Do you have transportation?*
1. Yes
2. No
Emergency Contact Information
Please list your nearest friend or relative not living with you.
First Name*
Last Name*
Street Address*
City*
State*
Zip Code*
Contact Phone Number*
Relationship*
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Employment and References

Work Experience
Most Recent / Current Employer
Business Name
Title
Address
City
State
Zip Code
Phone Number
Supervisor's Name
Dates Worked
Dates Worked Start Date
—
Dates Worked End Date
Duties
May we contact?
1. Yes
1. No
Reason for Leaving?
Former Employer
Business Name
Title
Address
City
State
Zip Code
Phone Number
Supervisor's Name
Dates Worked
Dates Worked Start Date
—
Dates Worked End Date
Duties
May we contact?
1. Yes
1. No
Reason for leaving?
Volunteer Experience*
List all prior or current volunteer experience. Please include the organization, phone number, date range you volunteered, approximate number of hours volunteered and duties. If none, please list N/A.
Are you a high school graduate or passed the GED test?*
1. Yes
1. No
Education and Training*
Please list any education and training beyond high school. Please include the school(s) attended, dates attended and certificates or degrees earned. If none, please list N/A.
List of References
MUST list six (6) total - Three (3) Family Reference and three (3) Outside References. A family reference is a spouse, child, sibling or parent. An outside reference is a friend, co-worker, roommate, landlord, etc.
Family Reference #1
A family reference is a spouse, child, sibling or parent.
First Name *
Family Reference #1
Last Name *
Family Reference #1
Mailing Address*
Email Address*
Contact Phone Number*
Family Reference #1
Email Address
Family Reference #1
Relationship*
Family Reference #1
Family Reference #2
A family reference is a spouse, child, sibling or parent.
First Name*
Family Reference #2
Last Name*
Family Reference #2
Mailing Address*
Email Address*
Contact Phone Number*
Family Reference #2
Email Address
Family Reference #2
Relationship*
Family Reference #2
Family Reference #3
A family reference is a spouse, child, sibling or parent.
First Name*
Family Reference #3
Last Name*
Family Reference #3
Mailing Address*
Email Address*
Contact Phone Number*
Family Reference #3
Email Address
Family Reference #3
Relationship*
Family Reference #3
Outside Reference #1
An outside reference is a friend, co-worker, roommate, landlord, etc.
First Name*
Outside Reference #1
Last Name*
Outside Reference #1
Mailing Address*
Email Address*
Contact Phone Number*
Outside Reference #1
Email Address
Outside Reference #1
Relationship*
Outside Reference #1
Outside Reference #2
An outside reference is a friend, co-worker, roommate, landlord, etc.
First Name*
Outside Reference #2
Last Name*
Outside Reference #2
Mailing Address*
Email Address*
Contact Phone Number*
Outside Reference #2
Email Address
Outside Reference #2
Relationship*
Outside Reference #2
Outside Reference #3
An outside reference is a friend, co-worker, roommate, landlord, etc.
First Name*
Outside Reference #3
Last Name*
Outside Reference #3
Mailing Address*
Email Address*
Contact Phone Number*
Outside Reference #3
Email Address
Outside Reference #3
Relationship*
Outside Reference #3
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Drug Use Questionnaire

Personal History Information

Personal History Information
Convictions
Conviction of a crime is not necessarily a bar to volunteer service. Each case is considered separately based on job requirements.
Have you ever been convicted by any court of an offense?*
DO NOT include: A) Minor traffic violations (fines of $75 or less). B) Any offense committed prior to your 18th birthday, which was fully adjudicated in Juvenile Court or under a youth offender law. C) Any incident sealed under Welfare & Institutions Code 781 or Penal Code 1203.45.
1. No
1. Yes
If “YES”, state what offense, when, where, and disposition of case.*
If not applicable, please list N/A.
Is there anything in your past, which might disqualify you from functioning as a volunteer for the Woodland Police Department?*
1. No
1. Yes
If “YES”, describe briefly:*
If not applicable, please list N/A.
Release of Information*
As a volunteer for a position with the Woodland Police Department, I am willing to furnish information for use in determining my qualifications. In this connection, I authorize release of any and all information that you may have concerning me, including information of a privileged nature.
1. I agree.
Release of Liability*
I hereby release you, your organization, or others from liability for damage, which may result from furnishing the information required.
1. I agree.
Fingerprint Advisement*
I understand that for security reasons a basic clearance check will be conducted and I will be fingerprinted. Further background will be required only if a specific volunteer assignment calls for a full security check.
1. I understand.
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Applicant Waiver

Volunteers in Policing Applicant Waiver
I am an applicant in the Volunteers In Policing program with the City of Woodland Police Department. A background investigation will be conducted to determine my fitness to serve as a volunteer.
Authorization*
I hereby direct you, your organization, its Custodian of Records, and/or persons in your employ to release any and all information which you may have concerning me, including, but not limited to: employment information, official employment documents, employment performance data, character reference information, educational records and transcripts (pursuant to Public Law 93-380), medical, surgical, psychological and dental records if I am offered employment/Volunteer opportunity with this agency (pursuant to the Medical Information Act, Civil Code Section 56 et seq. and 29 C.F.R. 1630), credit and financial information (pursuant to the Banking Privacy and Fair Credit Reporting Acts), local criminal history information (pursuant to Penal Code Section 13300[b][10]), and/or any other information which you may possess.
1. I agree.
Information Release*
I exonerate, release and discharge you, your organization, its officers, agents, and assigns, from any liability or damages, whether in law or in equity, now and in the future, for furnishing the information requested by the bearer of this authorization form.
1. I agree.
Waiver of Rights*
I have specifically and permanently waived any rights I may have to review or inspect any and all information developed in this investigation so your responses will be completely confidential pursuant to Labor Code Section 1198.5. You may retain this form for your files.
1. I agree.
Certification*
I certify that I have read this authorization form, understand its meaning and purpose, and have received a copy of it. I may revoke this authorization at any time by delivering, in writing, such revocation to you/your organization.
1. I agree.
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.
Electronic Signature*
Date of Birth*
Date of Birth
Today's Date*
Today's Date
THIS RELEASE EXPIRES 120 DAYS FROM DATE OF SIGNATURE
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Authorization Forms

Authorization Forms
Use of Criminal Justice Information Disclaimer*
As a volunteer for the WOODLAND POLICE DEPARTMENT, you may have access to confidential criminal record information. Misuse of such information may adversely affect the civil rights of the individual concerned and violates the law (Sections 502, 11105, 11140, 11144, 13300, and 13305 of the California Penal Code, and 19251, 6200 and 6201 of the California Government Code). These codes state, in part: “Any persons authorized by law to receive a record of information obtained from a record, or any employee of the local criminal justice agency who knowingly furnishes the record or information to a person who is not authorized by law to receive the record or information is guilty of a misdemeanor.” Such misuse is a misuse under California law. Therefore any volunteer who is responsible for such misuse is subject to immediate dismissal. Violations of this law may also result in civil and/or criminal penalties. This signed form will be placed in your personnel file.
1. I understand.
Statement of Knowledge and Compliance with Child and Elder Abuse Laws
Welfare and Institutions Code 15630(a) states: Any person who has assumed full or intermittent responsibility for the care or custody of an elder or dependent adult, whether or not he or she receives compensation, including administrators, supervisors, and any licensed staff of a public or private facility that provides care or services for elder or dependent adults, or any elder or dependent adult care custodian, health practitioner, clergy member, or employee of a county adult protective services agency or a local law enforcement agency, is a mandated reporter. Welfare and Institutions Code 15630(b)(1) states: Any mandated reporter who, in his or her professional capacity, or within the scope of his or her employment, has observed or has knowledge of an incident that reasonably appears to be physical abuse, as defined in Section 15610.63 of the Welfare and Institutions Code, abandonment, abduction, isolation, financial abuse, or neglect, or is told by an elder or dependent adult that he or she has experienced behavior, including an act or omission, constituting physical abuse, as defined in Section 15610.63 of the Welfare and Institutions Code, abandonment, abduction, isolation, financial abuse, or neglect, or reasonably suspects that abuse, shall report the known or suspected instance of abuse by telephone immediately or as soon as practicably possible, and by written report sent within two working days Section 11166 of the Penal Code requires any child care custodian, health practitioner, firefighter, animal control officer, or humane society officer, employee of a child protective agency, or child visitation monitor who has knowledge of, or observes, a child in his or her professional capacity or within the scope of his or her employment whom he or she knows or reasonably suspects has been the victim of child abuse to report the known or suspected instance of child abuse to a child protective agency immediately, or as soon as practically possible, by telephone and to prepare and send a written report thereof within 36 hours of receiving the information concerning the incident.
Statement of Knowledge and Compliance with Child and Elder Abuse Laws Ackowledgement*
I hereby acknowledge and certify that I have read and understand the provisions of the above Welfare and Institutions Code Sections regarding DEPENDENT ADULT ABUSE, and the above Penal Code Sections regarding CHILD ABUSE, and that I shall comply with the above laws as an employee of the Woodland Police Department and further understand that this signed and witnessed document shall become a permanent part of my Personnel File.
1. I understand.
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Commitment Form

Volunteer Applicant Commitment Form
1. I understand that, pending background and interview, I am volunteering for a minimum of six (6) months with a minimum of 5 hours per month.*
1. I understand.
Potential Conflicts
Please explain any potential conflicts that you foresee regarding your volunteering with the Woodland Police Department.
2. I understand that I will be required to attend the initial training sessions, hands-on training and additional on-going training, as needed.*
1. I understand.
3. I understand that the Police Department is required to complete background checks on all volunteer applicants prior to being accepted as a volunteer.*
1. I understand.
4. I understand that the Police Department reserves the right to withdraw my volunteer status at any time for any reason.*
1. I understand.
5. I understand that I will not be paid for my time or services, I am not officially an employee of the City of Woodland and I may not represent myself as anything other than a volunteer.*
1. I understand.
6. I am seeking the opportunity to become a volunteer for the City of Woodland voluntarily and no promises, agreements, or other inducements have been made.*
1. I agree.
Application Verification*
I have read and understand the above minimum requirements for volunteers of the Woodland Police Department. I certify that all statements and answers on this form are true and complete.
1. I agree.
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.
Electronic Signature*
Today's Date*
Today's Date
THANK YOU!
Thank you for completing the Volunteers in Policing Application. Once your application is submitted, it will be reviewed and you will be contacted. Please allow some time for us to process this application. If you have any questions or need assistance, please contact Volunteer Coordinator, Vanessa McKenzie, at Vanessa.Mckenzie@cityofwoodland.gov or 530-661-7875.

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Volunteers in Policing Program Application

Steps

Step One

Health Information

Employment and References

Drug Use Questionnaire

Personal History Information

Applicant Waiver

Authorization Forms

Commitment Form

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