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    This application is to assist in the process of referring you to the Kanabec County Sheriff's Office for a possible position as a volunteer. Certain information requested on the application is private, that is, it may be released only to you or the Kanabec County Sheriff's Office.
PRIVATE DATA: Why we ask for the information and what may happen if you don't provide the information.
NAME: To distinguish you from all other applicants. Failure to provide information may be cause for rejecting an application.
ADDRESS: To be able to send you notices. Failure to provide information may be cause for rejecting an application.
PHONE: To be able to contact you to determine your availability for an interview and any program schedule changes.
CONVICTIONS: To determine whether we may legally accept an application from you. To determine whether your record may be a job-related conviction.

   I hereby authorize and grant consent to the Kanabec County Sheriff's Office, its agents and/or representatives to obtain and collect information about me, including information that has been classified as private, as defined by Minnesota Statute 13.02, Subdivision 12. The information includes all data collected, created, received, retained or disseminated relating to my dealings with an individual or agency.
 I understand that the information gathered will aid in determining my suitability for a volunteer position with the Kanabec County Sheriff's Office.
This authorization is valid for one year, but I have the right to cancel it by providing a written notice. A photocopy of this authorization will be treated in the same manner as the original.

I have read the Tennessen warning above.       
I agree with the above "Authorization to Release Information."       
Name: Last, First Middle
Date of Birth    
Driver's License Number State?  
Address Line 2:
City or Town:
State or Province:
Zip or Postal Code:
Volunteer Position Interest?  
Pilot Outreach          
Bible Study          
Parenting Class          
Alcoholics Annonymous          
Narcotics Annonymous          
Dates and times you are available to volunteer.       
Please explain why you want to volunteer.       
List any other volunteer experience.       
Please list 3 character or work references to validate your   
     application. List name, address, and phone.     (Non family members please)    
Have you ever been convicted of a crime? If yes, please explain.         
Have you been incarcerated in the Kanabec County Jail
in the past 24 months?    
  Yes    No    
Are you currently on probation or parole?   Yes    No     
If yes, please list agents name and number.       
Please list emergency contact information.      
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