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Minto-Brown Island Park Patrol Application

Department of Community Services

Parks Operations Division

1460 20th St SE/ Bldg. #14 Salem, Oregon 97301-3503
Phone: 503-588-6336   FAX 503-588-6305

 

____________________________________________________________________________
Last Name                                                 First                                          Middle Initial
 
____________________________________________________________________________
Date of Birth                                             Work Phone                              Home Phone
____________________________________________________________________________
Mailing Address                                                                 City                                      ZIP Code
 
Emergency Contact: __________________________   Phone Number: ___________________
*Minimum 8 hours per month required

 

Have you ever been convicted of a misdemeanor or felony?   ___Yes   ___No

If yes, please describe: _______________________________________________________________

__________________________________________________________________________________

Note: A conviction will not necessarily bar you from volunteering. Each conviction will be judged on its own merits with respect to time, circumstances, and seriousness.

 

Driver's License Number: _________________________________ State of Issue: __________


Why do you want to be a member of the Minto-Brown Island Park Patrol?

________________________________________________________________________________

________________________________________________________________________________

________________________________________________________________________________

________________________________________________________________________________

 
By my signature below, I understand and agree to information above and certify that all answers to the questions and statements on the application are true and complete to the best of my knowledge. I understand that, should the City learn, at any time, of any misleading answers, my application may be rejected and my name removed from further consideration.

_____________________________________                             _________________________
Signature                                                                                        Date

Please return signed application to the above address. Thank you.

 

 

 

 

 

 

Emergency
Information

 


All Parks Events

 

Map of Parks (pdf)

 

Parks Operations Division
1460 20th St SE
Salem, OR 97301
503-588-6336
Fax: 503-588-6305
SalemParks@cityofsalem.net
More Contacts

 

Page Last Modified: July 9, 2008

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