VolunteerChaplainApplication

WACO POLICE DEPARTMENT VOLUNTEER CHAPLAIN APPLICATION

First Name

Last Name

Date of Birth

mm/dd/yy

Home Address

City, State and Zipcode

Phone Number

555-555-5555

Email Address

Driver’s License Number

Sex

Male Female

Race

Martial Status

Single Married

Religious Denomination

Ecclesiastical Endorser

Highest Education Level

Religious Education

MDiv ThM DMin

Other*

Conferred by:

HAVE YOU EVER:

Been arrested?

NO YES

If yes please explain*

Been convicted of an offense other than a minor traffic violation?

NO YES

If yes please explain*

Used an illegal substance?

NO YES

If yes please explain*

Participated in a public demonstration?

NO YES

If yes please explain*

Briefly discuss how your ministry of presence would be of value to the commissioned officers and civilian employees of the Waco Police Department

Attach to this form a copy of your ordination certificate and your ecclesiastical endorsement. These documents are required

AUTHORIZATION FOR BACKGROUND CHECK
I authorize the Waco Police Department to conduct a background check pursuant to my application to become a Volunteer Police Chaplain

Social Security Number