HomeMy WebLinkAboutCOPS ApplicationPalm Desert Citizens On Patrol
45480 Portola Avenue
Palm Desert, CA 92260
(760) 862-9848 www.palmdesert.gov
C I T Y O F P A L M D E S E R T
Thank you for your interest in participating in the Palm Desert Citizens On Patrol Program. Our
program is open to participation by all residents of the Coachella Valley, you do not have to be a
resident of Palm Desert. Even though we only patrol Palm Desert, our program is a great opportunity
to assist all residents of the Coachella Valley as they pass through our great city.
The application packet contains the following forms:
1. ____ General information
2. ____ Related Experience
3. ____ Job Description
4. ____ Medical Clearance Form
5. ____ Notice of Confidentiality of City/Sheriff’s Department Information
6. ____ Acknowledgment Waiver
7. ____ No Feedback Waiver
8. ____ Palm Desert Sheriff’s Station Ride-A-Long Application
9. ____ Sheriff’s Waiver and Release of Claims
10. ____ RSVP Volunteer Application
11. ____ DMV Authorization for Release of Driver Record Information
12. ____ Sheriff’s Department Volunteer Disaster Service Worker Registration Form
Please be sure to complete all the above forms. You will need to take forms 3 and 4 to your doctor to
complete and return to you. All the forms must be complete before we can proceed with your
application. To assist you with this, we have left a space beside each form to place a check as it is
completed. Incomplete application packages can not be processed.
If you have any questions regarding the forms, you can contact CSO Stacey Austin at 760-836-1600.
When all forms are complete, please place them in an envelope (for privacy) and return them to CSO
Stacey Austin at the below address. Once she receives your completed packet, she will contact you to
start the process. As part of this process, the Sheriff’s Department will perform a background record
check and Livescan (fingerprint check) at no cost to you.
CSO Stacey Austin
73705 Gerald Ford Drive
Palm Desert, CA 92260
760-836-1600
CITY OF PALM DESERT
CITIZENS ON PATROL
VOLUNTEER APPLICATION
GENERAL INFORMATION
NAME PHONE
PRESENT ADDRESS
CITY STATE ZIP
EMAIL ADDRESS
EMPLOYMENT FROM TO
DRIVERS LICENSE STATE EXPIRATION DATE
Please attach copy of drivers license
SOCIAL SECURITY NUMBER (optional) D.O.B.
HEIGHT WEIGHT HAIR EYES SEX BLOOD TYPE
ALLERGIES
MEDICATIONS
PHYSICAL LIMITATIONS
HAVE YOU BEEN CONVICTED OF A CRIME IN THE PAST TEN YEARS?
(excluding misdemeanors and summary offenses)
IF YES, PLEASE DESCRIBE IN FULL
PLEASE LIST ANY OTHER CREDENTIALS OR SKILLS SUCH AS BUSINESS SKILLS, CP,
COMPUTER, ETC.
LANGUAGES SPOKEN
PLEASE INDICATE THE NUMBER OF HOURS PER WEEK THAT YOU CAN VOLUNTEER
FOR THE COPS PROGRAM
EMERGENCY CONTACT INFORMATION
NAME RELATIONSHIP PHONE
CITY OF PALM DESERT
CITIZENS ON PATROL PROGRAM
VOLUNTEER APPLICATION
BIOGRAPHICAL SKETCH
PLEASE INCLUDE ANY PERTINENT INFORMATION SUCH AS CIVIC INVOLVEMENT,
EDUCATION, WORK EXPERIENCE, GOVERNMENT AGENCY CLEARENCES AND ANY
OTHER SUPPLEMENTAL MATERIAL RELEVANT TO SERIVING AS A COPS VOLUNTEER:
PLEASE LIST BELOW ANY ALIASES/OTHER NAMES USED
CITY OF PALM DESERT
CITIZENS ON PATROL PROGRAM
VOLUNTEER APPLICATION
RELATED EXPERIENCE
PLEASE ATTACH A CURRENT RESUME OF YOUR WORK AND EDUCATONAL HISTORY
BEGINNING WITH THE COMPLETION OF HIGH SCHOOL.
“I CERTIFY THAT THE STATEMENTS MADE BY ME ON THIS APPLICATION ARE
TRUE, COMPLETE, AND CORRECT TO THE BEST OF MY KNOWLEDGE AND BELIEF AND
ARE MADE IN GOOD FAITH. I AGREE THAT I WILL VOLUNTEER A MINIMUM OF TWENTY
(20) HOURS PER MONTH UNLESS GRANTED A LEAVE OF ABSENCE.”
SIGNATURE OF APPLICANT DATE
RECOMMENDED BY
PLEASE RETURN APPLICATION TO: SHERIFFS DEPARTMENT
ATTN: COPS PROGRAM
73-705 Gerald Ford Dr.
Palm Desert, CA 92211
SALARY:
DEPARTMENT:
OPENING
DATE:
JOB
FUNCTIONS:
CITY OF PALM DESERT
invites applications for the position of:
C itizens O n Patrol (CO PS)
V olu nteer
$0
Citizens On Patrol
Ongoing
•Patrol neighborhoods, businesses, and Districts in Palm Desert
•Assist with traffic control at collisions, hazards, and events
•Conduct vacation home checks
•Participate in City events with road closures
•Participate in special events with the City and Sheriff’s Department by having a booth/space
•Participate in Holiday Theft Suppression by extra patrolling major shopping centers (Mall, El
Paseo, etc.)
•Attend monthly COPS meetings
•Write parking warnings for parking violations
•Monitor Sheriff's dispatch radio
•Support functions of other City departments
PHY SICAL DEMANDS
When working within an office environment, must possess mobility to work in a standard office
setting and use standard office equipment, including a computer; vision to read printed
materials and a computer screen; and hearing and speech to communicate in person and over
the telephone; ability to stand and walk between work areas may be required. Finger dexterity is
needed to access, enter, and retrieve data using a computer keyboard or calculator and to
operate standard office equipment. Volunteers occasionally bend, stoop, kneel, reach, push, and
pull drawers open and closed to retrieve and file information.
When working out in field, must possess mobility to work in changing site conditions; possess the
strength, stamina, and mobility to perform light to medium physical work; to sit, stand, and walk
on level, uneven, inclined, or slippery surfaces; to reach, twist, turn, kneel, and bend, to
climb and descend ladders; and to operate a motor vehicle and visit various City sites; vision to
inspect site conditions and work in progress.
The job involves fieldwork requiring frequent walking in operational areas to identify problems or
hazards, with exposure to ha zardous materials in some site locations. Volunteers must possess the
ability to lift, carry, push, and pull materials and objects averaging a weight of 40 pounds with the use
of proper equipment. Reasonable accommodations will be made for individuals on a case-by-case
basis.
CITY OF PALM DESERT
CITIZENS ON PATROL
VOLUNTEER APPLICATION
MEDICAL CLEARANCE FORM
Dear Physician:
wishes to participate in t he Citizens o n Patrol (COPS)
Program t o serve as an A mbassador f or t he City of P alm Des ert.
Please provide any information that may limit or prohibit this applicant from volunteering
in the COPS Program. This completed form should be returned to your patient with
restrictions that are appropriate. In signing this form, I attest that I have read the job
functions and physical demands of this position, and certify that this individual is
medically qualified to participate in the COPS Program.
Physician's Signature Date
Physician's Name (printed)
Physician's Address and Phone Number
Thank you for your assistance. If you have any questions regarding this program,
please call the City Manager’s Office at Palm Desert City Hall (760) 346-0611.
PALM DESERT CITIZENS ON PATROL
45480 Portola Avenue
Palm Desert, CA 92260
(760) 862-9848 www.palmdesert.gov
NOTICE OF CONFIDENTIALITY OF CITY/POLICE DEPARTMENT INFORMATION
1.Volunteers shall not disclose or allow access to information contained in or obtained from
Local Summary Criminal History Information, records maintained by State Department of
Justice, or material, documents and information received from the Federal Bureau of
Investigation or any other agency of State or Federal government, unless such disclose or
access is authorized by law.
2.Volunteers shall not use any information derived from any City or Police Department
sources or records for personal gain or use, except as authorized by law or City or Police
Department policies and procedures.
3.Volunteers shall not permit any person to receive information connected with the operation
of the City of Police Department without permission of the respective agency or as otherwise
provided by law or City or Police Department policies and procedures.
4.Volunteers shall not disclose to anyone the fact to the nature of any investigation, except as
provided by law or City or Police Department policies and procedures.
5.Volunteers shall not give any unauthorized person any information concerning the location
of records, weapons, ammunition, the number of officers on duty, shift assignment or patrol
beat area.
6.Serving the public provides each of us with great responsibility. Consequently, there can be
no compromise in the requirement for all volunteers to follow the City and Police Department
policies and procedures on records and information and this “Notice of Confidentiality of
City/Police Department Information”. Any violation of said subject by a volunteer may result
in severe disciplinary action and/or termination.
7.Penal Code, Section 11142 relating to State Summary Criminal History information provides
as follows: Any person authorized by law to receive a record or information obtained from a
record 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.
8.Penal Code, Section 13302 relating to Local Summary Criminal History Information provides
as follows: Any person of the local criminal justice agency who knowingly furnishes a record
or information obtained from a record to a person who is not authorized by law to receive the
record or information is guilty of a misdemeanor.
I have read and understand the “Notice of Confidentiality of City/Police Department Information”
Printed Name Signature
Date
PALM DESERT CITIZENS ON PATROL
45480 Portola Avenue
Palm Desert, CA 92260
(760) 862-9848 www.palmdesert.gov
ACKNOWLEDGMENT WAIVER
Name
Address
You will undergo a rigorous, in-depth background investigation as a result of your
application for a volunteer position with the City of Palm Desert. In the event that your
background investigation should uncover information that leads to a belief that you have
or are engaged in illegal activities, we will notify the appropriate law enforcement
agency for their continued investigation and possible prosecution.
I have read the above notice and understand that any information concerning
criminal activity that I have participated in is NOT protected by any form or
confidentiality, regardless of where the information came from. I understand that any
information discovered about me during the background process, may be used against
me in further criminal investigation and prosecution. (Initial here)
Failure to notify the City of Palm Desert of any changes during the background
investigation can be grounds to deny your application. In addition, unreported law
enforcement contacts will be cause for immediate disqualification.
Signature Date
PALM DESERT CITIZENS ON PATROL
45480 Portola Avenue
Palm Desert, CA 92260
(760) 862-9848 www.palmdesert.gov
NO FEEDBACK WAIVER
Name
Address
I understand that that the background investigation performed as an applicant for
the Palm Desert Citizens on Patrol (COPS) Program is for security purposes only. It
is to assess qualifications for this specific position and is in no way to be construed as
intended for any other purposes.
I understand that I will be given NO FEEDBACK or results other than being
notified of “passing” or “not passing”. Also, I acknowledge that these records are
confidential and will be the property of the Palm Desert Police Department and will not
be made available to any other law enforcement agency or employer without a Personal
Information Waiver signed by me.
MEMBERSHIP DENIAL
Also, if I am not recommended to become a COPS volunteer, I understand that I
will be given NO FEEDBACK as this means only that I do not meet the standards
established for the COPS Program.
Signature Date