NORCO
C.O.P.

Citizens On Patrol
Volunteer Data

Please Print:

Full Name:_________________________________________________

Address:__________________________________________________

Home Phone:_________________ Message Phone:________________

D.O.B.:________________________CDL:_______________________

Have you ever had or do you now suffer from any serious injury or disability?
No________   Yes_______  (If yes, please explain on a separate sheet of paper.)

Have you ever been arrested or convicted of any offense other than a minor traffic violation?
No________   Yes_______  (If yes, please explain on a separate sheet of paper.)

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

List the hours during the various days that you wish to patrol:

Sunday___________________________         Thursday___________________________

Monday___________________________         Friday_____________________________

Tuesday__________________________         Saturday___________________________

Wednesday_______________________        

I hereby state that all information supplied in the application is true.  I also authorize the City of Norco and the Sheriff's Department to verify this information and to conduct a criminal history check.

Signed_____________________________________  Date__________

Mail completed Volunteer applications to:  Norco City Hall - Sheriff's Department
                                                              Attn:  Deputy Hedge
                                                              P.O. Box 428
                                                              Norco, CA 91760