City Forms

4. First Name*
5. Last Name*
6. Middle Name
8. Street Address*
10. City*
11. State*
12. Zip Code*
14. Phone Number*
15. Email Address*
17. Date of Birth*

    Format MM/DD/YYYY

18. Current Age*
20. Height*

    Feet' Inches"

21. Weight*

    lbs.

22. Hair Color*
23. Eye Color*
25. Current Grade in School*
26. School Currently Attending*
27. School Principal's Name*
31. Father's First Name*
32. Father's Last Name*
33. Father's Middle Name
35. Father's Mobile Phone Number*
36. Father's Work Phone Number
38. Father's Occupation / Position
39. Father's Place of Business / Employer
41. Father's Address (If different than yours)
43. City
44. State
45. Zip Code
49. Mother's First Name*
50. Mother's Last Name*
51. Mother's Middle Name
53. Mother's Mobile Phone Number*
54. Mother's Work Phone Number
56. Mother's Occupation / Position
57. Mother's Place of Business / Employer
59. Mother's Address (If different than yours)
61. City
62. State
63. Zip Code
67. Brothers and Sisters Living with You
69. First and Last Name
70. Age
72. First and Last Name
73. Age
75. First and Last Name
76. Age
78. First and Last Name
79. Age
81. First and Last Name
82. Age
86. Family Physician
87. Phone Number
89. Address
91. City
92. State
93. Zip Code
95. Hospital Preference*
96. Hospital Phone *
100. Emergency Contact Other than Parents
102. First Name*
103. Last Name*
104. Phone Number*
106. Address*
108. City*
109. State*
110. Zip Code*
114. Are you active with any organizations or clubs?*

     1. Yes
     2. No
115. If Yes, which?
117. Organization / Club Street Address
119. Do you hold a leadership position within the organization?

     1. Yes
     2. No
120. If Yes, which position?
124. What hobbies, skills, and other interests do you have?*
128. Do you have a career or job planned for the future? If so, what is it?*
132. Are you currently employed?*

     1. Yes
     2. No
133. If yes, where?
135. What are your duties?
139. Do you have a driver's license?*

     1. Yes
     2. No
140. If yes, Driver's License #
144. Have you ever received a traffic citation?*

     1. Yes
     2. No
145. If yes, where and for what?
149. Have you ever been detained by a law enforcement agency?*

     1. Yes
     2. No
150. Have you ever been arrested by a law enforcement agency?*

     1. Yes
     2. No
152. If yes to either the above, by which agency and for what reason?
156. Is any member of your family associated with law enforcement?*

     1. Yes
     2. No
157. If yes, please give their name, agency, and position.
161. Please enter the name, address, and phone number of three adult references who know you well (not relatives).
163. First and Last Name*
164. Phone Number*
166. Street Address*
168. City*
169. State*
170. Zip Code*
174. First and Last Name*
175. Phone Number*
177. Street Address*
179. City*
180. State*
181. Zip Code*
185. First and Last Name*
186. Phone Number*
188. Street Address*
190. City*
191. State*
192. Zip Code*
196. Media Release

     I hereby grant Ridgecrest Police Department and the City of Ridgecrest, their successors and/or assigns permission to use my likeness in a photograph, video, digital, or other medium in any and all of its publications, including website entries and social media, or promotional materials without payment or any other further consideration.

197. I accept the entirety of this Media Release.*

     1. Yes
     2. No
199. Please type your first and last name in place of ink signature.*
203. Statement of Acknowledgement

     I understand that any portion of this application is subject to further examination by the Ridgecrest Police Department.  

     I acknowledge all the information contained within this application will be used solely for the Ridgecrest Police Explorer post and for no other purpose.
     
     All of the information contained in this application is correct to the best of my knowledge.
     
     

204. I accept the Statement of Acknowledgement.*

     1. Yes
     2. No
206. Please type your first and last name in place of ink signature.*
208. If applicant is under 18 years old, a parent / guardian signature is required.
     Please type the name of the consenting parent or guardian. Once application is received parent's authorization will be verified.
Leave This Blank:


210. 1. Receive an email copy of this form.
211. Email address

     This field is not part of the form submission.

212. Submit Submit and Print

* indicates a required field