PIMA COUNTY SHERIFF'S DEPARTMENT

SHERIFF'S AUXILIARY VOLUNTEERS

of the GREEN VALLEY DISTRICT, Inc.

601 North La Cañada Drive

Green Valley, Arizona 85614

(520) 351-6744

APPLICATION FOR MEMBERSHIP

NAME _______________________________________________ DATE ___________

ADDRESS _____________________________________________________________

ZIP _______________ PHONE _______________________

DATE OF BIRTH ___________________ SSN# ______________________

DRIVERS LICENSE # ___________________________ STATE _____

EXPIRATION DATE _____________________ BLOOD TYPE _______

HEIGHT ______ WEIGHT _______ EYE COLOR _____ HAIR COLOR ________

HIGH SCHOOL GRADUATE _____ YES ____ NO

COLLEGE YEARS COMPLETED _______________ MAJOR(S) _________________

DEGREE(S) ___________________________________________________________

ADDITIONAL EDUCATIONAL EXPERIENCE _________________________________

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OCCUPATION _____________________________________ YEARS ____________

OTHER EMPLOYMENT EXPERIENCE ______________________________________

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PHYSICAL DISABILITIES OR LIMITATIONS _________________________________

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HOBBIES / SPECIAL INTERESTS _________________________________________

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APPLICANT SIGNATURE ________________________________________________

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PLEASE RETURN THIS APPLICATION TO THE ABOVE ADDRESS