City of Palm Desert Citizens on Patrol Volunteer Application Packet

Packet Overview

Citizens on Patrol Volunteer Application

General Information

Emergency Contact Information

Biographical Sketch

Please include any pertinent information such as civic involvement, education, work experience, government agency clearances, and any other supplemental material relevant to serving as a COPS volunteer.

Related Experience and Certification

Please attach a current resume of your work and educational history beginning with the completion of high school.

Medical Clearance Form

Dear Physician:

wishes to participate in the Citizens on Patrol (COPS) Program to serve as an Ambassador for the City of Palm Desert.

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 any recommendations or restrictions that are appropriate.

Thank you for your assistance. If you have any questions regarding this program, please call our recruiting officer at (760) 862-9848.

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.”

Palm Desert Citizens on Patrol, 45480 Portola Avenue, Palm Desert, California 92260, (760) 862-9848, City of Palm Desert website.

Acknowledgment Waiver

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.

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.

No Feedback Waiver

I understand 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.

Riverside County Sheriff’s Department Ride-Along Application

Riverside County Sheriff’s Department. Chad Bianco, Sheriff.

To Be Completed by Employee Assigned

Agreement Assuming Risk of Death, Injury or Damage Waiver and Release of Claims

As used in this agreement, the term “law enforcement department” shall include the Sheriff’s Department of Riverside County and the Police Departments of the cities within Riverside County. The term “county” shall refer to Riverside County and the term “city” shall refer to every city within Riverside County as appropriate.

• I have read and initialed the section defining “law enforcement department,” “county,” and “city.”
• I understand that, as a non-member and non-employee, I voluntarily requested permission to ride as a guest or observer in a law enforcement vehicle and to accompany members during the active performance of official duties. I also understand that I must not interfere with any law enforcement duty unless requested to do so in an emergency, and that audio or video recording of any portion of the ride-along is strictly prohibited without express permission from the Department.
• I understand that the work and activities of the law enforcement department are inherently dangerous and involve possible risk of death, injury, damage, expense, or loss to person and property, and that the department did not take the initiative in extending an invitation to ride or accompany its members.
• I understand that sworn employees of another agency, from this state or another, must be in possession of full peace-officer powers to participate in a ride-along; that the undersigned rides in an off-duty capacity; that no law enforcement is to be conducted by the undersigned; and that no concealed weapon will be displayed unless it is during a life-threatening emergency for the protection of human life or the prevention of bodily injury.
• I agree that the city, the county, the law enforcement department, any member of a law enforcement department, and the driver or owner of any automobile owned, operated by, or in the service of the city or county, together with their sureties, shall not be held liable or responsible under any circumstances for any injury, damage, expense, or loss to person or property incurred while riding as a guest or observer or while accompanying a member of the department during the active performance of official duties as a peace officer.

Read and initial each section in this document before signing below.

RSVP Volunteer Application

RSVP, 78900 Avenue 47, Suite 200, La Quinta, CA 92253. Phone (760) 771-0501. Fax (760) 771-6267. Volunteers serving the Coachella Valley.

Confidential Information

Emergency Contact

Supplemental Insurance Beneficiary

Release of Information and Pictures

As a volunteer for RSVP, I hereby authorize the Riverside County Office on Aging, RSVP Volunteer Program to disclose pictures taken of me, information and or statements I have given through interviews with staff, in press releases, articles, newsletters or advertisements.

Vehicle Insurance Information

The following applies only to applicants whose volunteer service requires the use of their personal vehicle in the performance of the volunteer assignment.

I hereby certify that I now maintain the minimum liability insurance coverage, as required by the State of California. I further certify that I will continue to maintain this coverage for as long as I am a volunteer with the County of Riverside and drive my private vehicle or a County vehicle on official County business. I further certify that I now have and will continue to maintain a current Driver’s License issued by the State of California. I also certify that I have no medical conditions precluding me from safely operating a vehicle.

Volunteer Statement of Ethics and Confidentiality

I agree, as a volunteer, to conduct myself in accordance with the general and specific principles below:

A. Ethics

1. Volunteer/Customer Relationships

   I will maintain the confidentiality of all persons served. The nature of the work of the Agency or Department can be highly personal. It is paramount that I maintain the highest ethical standards.

2. Acceptance of Gifts

   As a Volunteer, I shall not accept any gift, bonus, gratuity, favor, or loan from any customer of the Agency or Department.

3. Appropriate Conduct

   I will refrain from participating in any activity in which my personal conduct is likely to result in inferior services, violations of the law, or behaviors, which would reflect negatively on the Agency or Department.

4. Drugs/Alcohol

   I will refrain from the use of alcohol or other mood-altering drugs while in the performance of my duties as a Volunteer.

B. Confidentiality

I understand and fully acknowledge the high degree of importance of exercising discretion and confidentiality regarding all information to which I am exposed as a result of being affiliated with the Riverside County Office on Aging.

I also recognize that I may have access to Agency personnel information, computer software and related documentation, financial records, minutes of meetings, methods of operation, and other information, which constitutes or contains confidential or proprietary information. I am also fully aware that I cannot share or discuss with anyone such confidential or proprietary information unless specifically asked to do so by my supervisor, either during the period I volunteer or for any time after I no longer am a volunteer with the RSVP Volunteer Program.

C. Conditions of Limited Confidentiality

There are certain specified conditions under which confidentiality is limited in order to protect the health and safety of others or myself. The specific conditions are:

1. Where there is known or suspected elder abuse.
2. Where there is known or suspected child abuse.
3. Where there are threats of violence or harm to someone.
4. Where there are threats of suicide.
5. Where there is a threat to public safety.

Employer Pull Notice Program Authorization for Release of Driver Record Information

California Department of Motor Vehicles, a Public Service Agency.

I hereby authorize the California Department of Motor Vehicles (DMV) to disclose or otherwise make available, my driving record, to my employer.

I understand that my employer may enroll me in the Employer Pull Notice (EPN) program to receive a driver record report at least once every twelve (12) months or when any subsequent conviction, failure to appear, accident, driver’s license suspension, revocation, or any other action is taken against my driving privilege during my employment.

I am not driving in a capacity that requires mandatory enrollment in the EPN program pursuant to California Vehicle Code (CVC) Section 1808.1(k). I understand that enrollment in the EPN program is an effort to promote driver safety, and that my driver license report will be released to my employer to determine my eligibility as a licensed driver for my employment.

I do hereby certify under penalty of perjury under the laws in the State of California, that I am an authorized representative of this company, that the information entered on this document is true and correct, to the best of my knowledge and that I am requesting driver record information on the above individual to verify the information as provided by said individual. This record is to be used by this employer in the normal course of business and as a legitimate business need to verify information relating to a driving position not mandated pursuant to CVC Section 1808.1. The information received will not be used for any unlawful purpose. I understand that if I have provided false information, I may be subject to prosecution for perjury (Penal Code Section 118) and false representation (CVC Section 1808.45). These are punishable by a fine not exceeding five thousand dollars ($5,000) or by imprisonment in the county jail not exceeding one year, or both fine and imprisonment. I understand and acknowledge that any failure to maintain confidentiality is both civilly and criminally punishable pursuant to CVC Sections 1808.45 and 1808.46.

To obtain a driver record on a prospective employee you may submit an INF 1119 form. To add this driver to the EPN Program you must submit the applicable forms: INF 1100, INF 1102, INF 1103, INF 1103A form. You may obtain forms at the California DMV Employer Pull Notice Program webpage or by calling 916-657-6346.

Sheriff’s Department Volunteer Disaster Service Worker Registration Form

Loyalty Oath under Code of Civil Procedure §2015.5 and Title 19, Div. 2, Chap. 2, Sub-Chap. 3, 2573.1.

Highlighted areas required by regulation.

Government Code §§3108-3109

Every person who, while taking and subscribing to the oath or affirmation required by this chapter states as true any material matter which he knows to be false, is guilty of perjury, and is punishable by imprisonment in the state prison not less than one nor more than 14 years. Every person having taken and subscribed to the oath or affirmation required by this chapter, who, while in the employ of, or service with, the state or any county, city, city and county, state agency, public district, or disaster council or emergency organization advocates or becomes a member of any party or organization, political or otherwise, that advocates the overthrow of the government of the United States by force or violence or other unlawful means, is guilty of a felony and is punishable by imprisonment in the state prison.

Loyalty Oath or Affirmation (Government Code §3102)

I,

do solemnly swear (or affirm) that I will support and defend the Constitution of the United States and the Constitution of the State of California against all enemies, foreign and domestic; that I will bear true faith and allegiance to the Constitution of the United States and the Constitution of the State of California; that I take this obligation freely, without any mental reservations or purpose of evasion; that I will well and faithfully discharge the duties upon which I am about to enter. I certify under penalty of perjury that the foregoing is true and correct.

This Block to Be Completed Only by Riverside County Sheriff’s Department

Revised 10/07/2003. A maximum of 5 years from the date of the Loyalty Oath is given.