Once you complete this form, you will be contacted to schedule an interview. If there are any questions you do not wish to answer at this time, please leave them blank and discuss them during the interview. Step 1 of 3 33% First Name* Middle Name Last Name* Email* Phone*Alternate PhoneAddress Street Address City State / Province / Region ZIP / Postal Code Are you At least 18 years of age* Yes No Driver's License Issuing StateEnter two character state abbreviation (CA, TX, NY) Driver's License Number Have you ever been convicted of a felony or misdemeanor Yes No If yes, please explainAre you willing to provide a DMV Driver Record Yes No If no, please explain: Prior Volunteer ServicePlease list prior or current volunteer service below.Name of Organization Organization Address Contact Name Contact Phone Number Additional Volunteer Service (optional)Please describe any additional volunteer service you have performed if it would be helpful for us to know. Work ExperienceDo you have any law enforcement, public safety, security, or military experience? If so, please describe. How would you describe your driving record and overall health?LimitationsDo you have any physical or personal issues you want to share that might affect or limit your participation?Night shiftMuch of our patrol work is late at night (Some shifts are until 3am). Is this acceptable to you? Yes No Collateral DutiesEach patroller has a collateral duty. Which of the following collateral duties would you be most interested in? Fundraising Recruiting Administration Public Outreach Internet and Social Media Coordination Training Vehicle care Volunteer coordination and retention Other (describe below) Other DetailsPlease explain your skills or interest in any areas you've selected above.EqualityAre you willing and able to treat everyone equally regardless of gender, race, religion, national origin, sexual orientation, marital status, or political preference? Yes No Physical InvolvementAre you willing to follow instructions about not becoming physically involved in incidents you might observe? Yes No Minimum CommittmentAre you willing to commit to providing a minimum 3 hrs/month of patrol or related service for one year? Yes No AwarenessHow did you become aware of Stonewall Citizens' Patrol and what do you know about us?MotivationWhy do you want to volunteer with Stonewall and what do you hope to personally gain from it?QuestionsWhat questions to you hope to have answered about Stonewall?AvailabiltyWhich dates/days of the week and times are you available for a 1 hour interview?Signature*By signing here, I certify that all the information on this form is true and correct. (Please type full name.) Δ
