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2. The City Of Ramsey Law Enforcement Explorer Post #(3819)

   is a division of the City of Ramsey Police Department. You will be trained in police practices and be exposed to classified information. Because of this, an intensive background investigation is performed on all applicants. Please fill out this application as completely as possible. If a question does not apply to you (such as Driver’s License information) please place N/A in the appropriate space. If you have any questions please feel free to contact an Advisor, brossum@ci.ramsey.mn.us or llohse@ci.ramsey.mn.us .

4. Personal Information
6. Position Title
8. First Name*
9. Middle Name*
10. Last Name*
11. Date of Birth*
13. Address: Street, City, State, Zip Code*
15. Email Address*
16. Home Phone*
17. Alternate Phone*
19. Driver's License*
    -- Select One --YesNo
20. Driver's License Number*
22. Parent/Guardian Information
24. Parent/Guardian 1:
26. First Name*
27. Middle Name*
28. Last name*
30. Address: Street, City, State, Zip Code*
32. Email Address*
33. Phone Number:*
35. Parent/Guardian 2:
37. First Name*
38. Middle Name*
39. Last Name*
41. Address: Street, City, State, Zip Code *
43. Email Address*
44. Phone Number
46. Education
48. Name of School*
49. Phone Number*
50. Grade*
52. School Counselor's Name*
54. Current Classes*
56. Sports/Clubs/Activities*
58. Awards, Certificates, Etc.*
60. Employment
62. Employer 1:
64. Employer*
65. Dates*
66. Position Title*
68. Address: Street, City, State, Zip Code*
70. Phone Number*
71. May we contact this employer?*
    -- Select One --YesNo
73. Supervisor*
74. Phone Number*
75. Email Address
77. Do you still work here?*
    -- Select One --YesNo
78. If no, list reason for leaving
80. Employer 2:
82. Employer*
83. Dates*
84. Position Title*
86. Address: Street, City, State, Zip Code*
88. Phone Number*
89. May we contact this employer?*
    -- Select One --YesNo
91. Supervisor*
92. Phone Number*
93. Email Address
95. Do you still work here?*
    -- Select One --YesNo
96. If no, list reason for leaving*
98. References: Please list people you have know for at least three years
100. Peer Reference 1:
102. Full Name*
103. Years known?*
105. Email Address*
106. Phone Number*
108. Briefly describe how you are acquainted with this person?*
110. Peer Reference 2:
112. Full Name*
113. Years known?*
115. Email Address*
116. Phone Number*
118. Briefly describe how you are acquainted with this person?*
120. Adult Reference 1:
122. Full Name*
123. Years known?*
125. Email Address*
126. Phone Number*
128. Briefly describe how are you acquainted with this person?*
130. Adult Reference 2:
132. Full Name*
133. Years known?*
135. Email Address*
136. Phone Number*
138. Briefly describe how you are acquainted with this person?*
140. Supplemental Questions: If a question does not apply to you, please place N/A in the appropriate space.
142. Are you between 14 (completed 8th grade)-21 years old?*

     1. Yes
     2. No
144. Are you enrolled in school and able to maintain C average or better?*

     1. Yes
     2. No
146. Do you have a good driving record?*

     1. Yes
     2. No
     3. Not applicable
148. Please list any tickets or accidents within the last three years?*
150. Have you ever been charged or convicted of ANY crime OR petty offense?*

     1. Yes
     2. No
152. If yes, please explain.*
154. Have you ever been listed as a runaway?*

     1. Yes
     2. No
156. If yes, please explain.*
158. Have you had any contact with the police or the court system (other than what you have mentioned above)?*

     1. Yes
     2. No
160. If yes, please explain. *
162. Have you ever been suspended or expelled from school?*

     1. Yes
     2. No
164. If yes, please explain.*
166. Please explain why you would like to become a Police Explorer.*
168. Where did you learn about this opportunity?
170. I certify that all answers to the above question are true and understand that any false information or omission of information from this application will be cause for rejection of this application or termination without notice.*

     1. Yes
     2. No
172. I authorize a representative of the City of Ramsey Police Department to contact any of the people listed.*

     1. Yes
     2. No
174. Electronic Signature Agreement *

     By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

     1. Agree
176. Applicant Electronic Signature*
178. Legal Guardian Electronic Signature (if under 18)*
Leave This Blank:


180. 1. Receive an email copy of this form.
181. Email address

     This field is not part of the form submission.

182. Submit Submit and Print

* indicates a required field