Meridian Police Department Volunteer Application for the Meridian Valley Humane Society * Denotes Required Fields * First Name: * Last Name: Address: * Street  * City   * State  How Long at Address: Idaho Resident? Yes No * Home Phone: Work Phone: Date of Birth: * E-Mail Address: * Drivers License Number:   * State    *  Expiration:   * Drivers License Ever Suspended? If yes, please explain Yes  No * Have You Ever Been Charged With a Felony Crime?   Yes   No If Yes, Please list date/location/crime: * Have You Ever Been Charged With a Misdemeanor Crime Within the Last 7 Years?   Yes   No If Yes, Please list date/location/crime: Current Employer: Title: Employer Address: Street    City     State   Supervisor: Phone: * Do you now belong to or have you ever been a member of any group whose aim was to discriminate against any person because of their race, sex, nationality, or religious affiliations? Yes   No If Yes, Please Explain: Indicate type of license / permit such as pilot, radio operator, CCW, etc., showing licensing authority, where the license was first issued, and date current license expires. Special skills and interests, or qualifications: What are your volunteer interests? Dog Adoption Dog Walker Fundraising Foster Home References: Please list three references and contact information: * Date:    * I verify that all the information submitted is true to the best of my knowledge.

Meridian Valley Humane Society • 3401 N. Ten Mile • Meridian Idaho 83646 • 794-0944
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