Application Form South Australia Police Volunteer (Page 3 of 4) in pdf

South Australia Police

RF2139

APPLICATION FORM

SOUTH AUSTRALIA POLICE VOLUNTEER

Criminal Associations and / or Relationships

Do you or any family member(s), relative(s) or associate(s) of your have an association with either (a) a person who has a criminal conviction or

reputation or (b) who is suspected of having a criminal conviction or reputation?

Yes

If you have answered YES to either (a) or (b) or both please provide an explanation below

(if space insufficient, please attach additional information

on a separate signed page).

Criminal History (and other relevant information)

Been apprehended, reported, cautioned or fined by the police or other law enforcement

Have you ever, in South Australia or

agency for the alleged commission of ANY offence?

Yes

elsewhere?

(including but not limited to shop-stealing, dishonesty, assault, property damage or drug

offences)

Been subject to domestic violence, firearms prohibition, restraining or other court order?

Yes

(Include accused or victim)

If you answered yes to ANY of the above questions, provide full details

(including State/Territory/Country in which the incident occurred)

Date

Details

Results

(if space insufficient, please attach additional information on a separate signed page)

Emergency Contacts

Please provide details of two emergency contact persons.

Family Name

Given Name(s)

Residential Address

Telephone

Declaration

I certify that all information given by me herein and in any attachments is to the best of my knowledge true and correct in every detail.

I understand that any questions not fully or correctly answered may render my application liable for disqualification, or cause my

registration as a SAPOL Volunteer to be withdrawn.

I understand that my criminal history information will be checked both within and outside South Australia for the purpose of identifying

any criminal history. I understand that I am also obligated to advise the relevant Volunteer Coordinator of any involvement in criminal court

proceedings. I hereby consent to South Australia Police (SAPOL) accessing any personal history and any other relevant information that any

Australian State / Territory / Federal Police or Law Enforcement Agency may have in its possession with reference to me. This includes any

convictions imposed on me that are spent or rehabilitated (however described) under State / Territory / Federal Legislation.

I understand that acceptance into the Police Volunteer Program is at the sole discretion of the Commissioner of Police.

Signature of Applicant:

Date:

Parent / Guardian Declaration

I am the parent / guardian of the person named on this application who is under the age of 18 years.

I give permission for him / her to apply as a Police Volunteer, and acknowledge that some Volunteer roles do require applicants to be over 18 years

of age.

I understand that any questions not fully or correctly answered may render the application liable for disqualification, or cause registration as a SAPOL

Volunteer to be withdrawn. I understand that any criminal history information will be checked both within and outside South Australia for the purpose

of identifying any criminal history.

Name:

Relationship to Applicant:

Date:

Signature of Parent / Guardian:

Date:

Revised: 22/09/2016

Page 3 of 4

Application Form South Australia Police Volunteer Page 3

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