Rochester, NY Police Department - Volunteer Application

A record check, which may take up to four weeks to complete, is conducted on all volunteer applicants. 
Position Applying For:  

Full Name
(First, M.I., Last):

Maiden Name:  
Current Address:  
Zip Code:  
How long at this address:  
Previous Address:  
Home Phone #:  
Cell Phone #:  
Work Phone #:  
Email Address:  
Emergency Contact Name:  
Emergency Contact Relationship:  
Emergency Contact Phone #:  
Type of transportation you will use:  
Education Background   
School Attended(ing):  
Date diploma received or expected:  
Military Service   
Time Served:  
Date Discharged:  
Employment History   
How Long Employed:  
Business Address:  
Previous Employment (please include business name, address, supervisor, and dates):   
Volunteer Background (please include names of organizations and dates of service):    
Skills (clerical, specific computer applications, work with youth, verbal and writtten communication, etc): 


Interest and Expectations (briefly state why you would like to volunteer with the RPD and what you hope to gain from the experience): 



References:  NOTE: Two should be work or school related.  None should be relatives. Include name, address, phone #, and relationship. 
Reference #1   
Reference #2  
Reference #3  
Special Limitations and Conditions:   
(list times):

*I certify that the above information is correct to the best of my knowledge.
*I authorize the City of Rochester to contact schools/colleges, former employers, references cited in this application in order to verify educational credentials, work/volunteer record, and personal character. 
*I understand that a criminal background check will be performed on all volunteer applicants.
*I understand that I may be terminated if the department becomes aware of criminal history while I am volunteering.
*I understand the commitment involved and acknowledge that my services are offered at my own risk.
*I agree to adhere to the Volunteer policies and carry out my duties as a volunteer effectively.
*I understand that my participation in this program does not make me an employee of the City of Rochester and I release the City of Rochester, its officers, agents, employees, and any third party organization from any and all liability for any claims of injury or damage of any kind whatsoever, as a result of my participation as a volunteer.
*I understand that I am not entitled to any benefits of employment including worker's compensation.
*I will maintain confidentiality of police information.
*I will not represent myself as an employee of the Rochester Police Department. 


Date:    [None] Select a Date Delete the Date 
Youth Volunteers And, if the applicant is under 16 years of age, I understand the above terms and give permission for my child to volunteer with the Rochester Police Department. 
Parent or Guardian Consent:  
Date:    [None] Select a Date Delete the Date 
Recommendation:  The Rochester Police Department recommends that volunteers be current on their Tetanus vaccination.