2. Marysville Crime Prevention Volunteer Application
4. Name*
6. Address1*
8. Address2*
10. City*
11. State*
12. Zip*
14. Home phone*
15. Cell phone*
17. Email address*
18. Date of birth*
20. Emergency contact person*
21. Emergency contact phone number*
25. Level of education*

    1. High School
    2. College
    3. Masters/PhD
26. Field of study*
27. Special training
29. Previous occupation(s)*
30. Interests or hobbies*
32. Describe other volunteer work you've done*
34. Have you ever been convicted of a felony?*

    1. Yes
    2. No
35. If you answered yes, please explain
37. How many hours a week are you available?*
38. Who or what prompted you to volunteer?
40. Reference #1*
42. Reference #2*
44. E-signature*
    My typing my name, I authorize the Marysville Police Department to do a background check of my driving record and my criminal record
45. Today's date*
    Today's date
Leave This Blank:


47. 1. Receive an email copy of this form.
48. Email address

    This field is not part of the form submission.

49. Submit

* indicates a required field