V.I.P.S. Application

2. First Name*

3. Middle Name

4. Last Name*

6. Date of Birth*

7. Address*

9. Main Phone Number*

10. Secondary Phone Number

12. E-Mail Address

13. Utah Driver's License Number*

15. Employer

16. Type of Employment

18. Please tell us why you are interested in becoming a V.I.P.S. volunteer:*

20. Do you have any special skills that may be valuable to the police department? If yes, please list:

22. Are you currently, or have you previously, volunteered for another law enforcement agency?*
    -- Select One --YesNo

23. What agency or agencies? And, in what capacities?

25. Do you live in Draper City?
    -- Select One --YesNo

26. Are you authorized to live in the United States?*
    -- Select One --YesNo

28. Have you ever been arrested for a criminal offense?*
    -- Select One --YesNo

29. Please explain:

31. Have you served in the United States Armed Forces?*
    -- Select One --YesNo

32. What Branch?

33. Did you receive a Honorable Discharge?
    -- Select One --YesNo

35. Have you attended the Draper Police Citizens Academy?*
    -- Select One --YesNo

36. What year?

38. In the last five years, have you used any illegal drug (including marijuana)?*
    -- Select One --YesNo

    A "Yes" answer does not automatically disqualify you.

39. Please explain the circumstances?

41. In the last five years, have you used any prescription drugs not prescribed to you or any prescription drugs not as prescribed?*
    -- Select One --YesNo

42. Please explain the circumstances:

44. Do you abuse or misuse alcohol?*
    -- Select One --YesNo

45. Please explain the circumstances:

47. Please read the following carefully:
    Applicants who are found to have committed any serious undetected crime may be excluded from consideration, whether or not an arrest or charges were made. Applicants who are found to have intentionally falsified or omitted any information from this application or other agency paperwork, will be disqualified from further consideration. All applicants will be required to have their physician complete a Volunteer Health Certificate form prior to beginning volunteer service with Draper City. I understand this application is for a volunteer position and will not be compensated. I understand participation as a volunteer shall not guarantee a job interview or job offer with Draper City. I understand this position does not give me any law enforcement authority.

    Applicants who are found to have committed any serious undetected crime may be excluded from consideration, whether or not an arrest or charges were made. Applicants who are found to have intentionally falsified or omitted any information from this application or other agency paperwork, will be disqualified from further consideration. All applicants will be required to have their physician complete a Volunteer Health Certificate form prior to beginning volunteer service with Draper City. I understand this application is for a volunteer position and will not be compensated. I understand participation as a volunteer shall not guarantee a job interview or job offer with Draper City. I understand this position does not give me any law enforcement authority.

49. By typing your full name below, you acknowledge that you have read all information on this application and that your answers are truthful.*

    To sign, please type your full name in the box.

Leave This Blank:


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

    This field is not part of the form submission.

53. Submit

* indicates a required field