Ride-Along Application - Town Of Cheswold Police Department Page 2
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1
2Ride-Along Application
NAME
DATE OF BIRTH
RACE
SEX
AGE
(Please Print)
HOME ADDRESS
CITY, STATE, ZIP
SOCIAL SECURITY #
HOME PHONE #
BUSINESS NAME
BUSINESS PHONE #
IN CASE OF EMERGENCY NOTIFY:
PHONE #
RIDING TIME DESIRED: (CHECK ONE)
DAY SHIFT
EVENING SHIFT
MIDNIGHT SHIFT
ND
REPORTING TIME
DAY OF WEEK DESIRED
2
CHOICE
HAVE YOU PARTICIPATED IN A CPD RIDE-ALONG WITHIN THE LAST 12 MONTHS?
YES
NO
WHAT PROMPTED YOUR INTEREST IN THE RIDE-ALONG PROGRAM?
(Town of Cheswold Police Department Use Only)
TO BE COMPLETED BY CHIEF OF POLICE
COMPUTER CHECK MADE
NO RECORD
RECORD ATTACHED
(Date)
APPLICANT NOTIFIED
BY
DATE
DATE AND TIME SCHEDULED RIDE-ALONG
ASSIGNED TO OFFICER(S)
APPROVED
DISAPPROVED
TERMINATED
TO BE COMPLETED BY OFFICER
WOULD YOU RECOMMEND THE INDIVIDUAL BE ALLOWED TO RETURN FOR ANOTHER RIDE-ALONG?
YES
NO
EXPLAIN
CHIEF OF POLICE OR
LEIUTENANT SIGNATURE
DATE
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