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2. 
3. Complete the below applications and we will contact you.
5. Select the Program you are Interested in Joining*
   -- Select One --Volunteer ProgramVictim Assistance Volunteer Program
7. Applicant Information
9. First Name*
10. Last Name*
12. Sex:*

    1. Male
    2. Female
13. Date of Birth*
15. Address1*
17. City*
18. State*
19. Zip*
21. Best Phone Number to Reach You*
22. Email Address*
24. Emergency Contact

    Please list someone to notify in case of an emergency.

26. Full Name*
28. Address
30. City
31. State
32. Zip
34. Emergency Contact Phone Number*
35. Name(s) of relative(s) employed by the Fort Myers Police Depatment?
37. Have you been arrested for anything other than a minor traffic offfense?*
    -- Select One --YesNo
38. If you have been arrested, please explain.
42. EDUCATION
44. Please select the highest level of education completed.
    -- Select One --GEDHigh SchoolAssociates DegreeBachelors DegreeGraduate/Masters Degree
45. List any specials skills or experience you possess here. (Ex. Accounting, law enforcement, etc.)
47. Foreign languages that you speak, read, write?
48. Medical Training? If yes, explain what type.
50. Please list all computer skills here.
54. WORK EXPERIENCE
56. Current Employer
57. Occupation
59. Business Address
61. City
62. State
63. Zip Code
65. Phone Number
67. List prior employment information here.
71. INTERESTS
73. List any previous community involvement and/or volunteer positions held:
74. List your hobbies/interests
78. OTHER INFORMATION
80. Do you have a valid Florida drivers license?*
    -- Select One --YesNo
81. Has your license ever been suspended, revoked, or denied?*
    -- Select One --YesNo
83. If your license has been suspended, revoked, or denied, explain why here:
85. What type of car insurance do you carry?
89. REFERENCES

    Please list three references, other than relatives, that you have know for at least one year:

91. First Name
92. Last Name
94. Address
96. City
97. State
98. Zip Code
100. Phone Number
101. Email Address
103. First Name
104. Last Name
106. Address
108. City
109. State
110. Zip Code
112. Phone Number
113. Email Address
115. First Name
116. Last Name
118. Address
120. City
121. State
122. Zip Code
124. Phone Number
125. Email Address
129. TO BE ANSWERED BY VICTIM ASSISTANCE VOLUNTEERS ONLY
131. Have you had previous experience in working with victims?
     -- Select One --YesNo
132. Have you been a crime victim?
     -- Select One --YesNo
134. If you have been a crime victim, please explain what happened if you feel comfortable doing so.
136. Except for vacations or emergencies, are you willing to give a 12-month commitment to the Victim Advocate Program?
     -- Select One --YesNo
137. If necessary, would you be willing to provide transportation for reluctant or disabled victims?
     -- Select One --YesNo
141. NOTICE TO ALL VOLUNTEER APPLICANTS

     It is a normal part of the Fort Myers Police Department procedures to perform background checks on the suitability of new personnel due to the nature and sensitivity of the work.  This standard is equally applicable to volunteers in that voluntary staff are treated with the same seriousness and consideration given to department members.  Successful completion of a background check is a qualification to work in certain units or programs of the department.

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143. 1. Receive an email copy of this form.
144. Email address

     This field is not part of the form submission.

145. Submit

* indicates a required field