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2. BILLINGS POLICE DEPARTMENT
   INTERN APPLICATION
   PO Box 1554
   Billings MT 59103
   406.869.3928
   pucketts@billingsmt.gov
   www.billingspolice.com

4. Date*
   Date
6. First Name*
7. Last Name*
9. Address1*
11. Address2
13. City*
14. State*
15. Zip
17. Phone*
18. Email
20. Social Security Number*
21. Date of Birth*
    Date of Birth
23. Place of Employment
25. Please list other names, if any, used on employment or education records:
27. Please list special skills, interests, and/or hobbies you have:*
29. List your current or previous experience with organizations, civic groups, volunteer experiences and clubs:
31. References
    Please list three references (only one may be related to you)
33. Name
34. Address
36. Phone Number
38. Name
39. Address
41. Phone Number
43. Name
44. Address
46. Phone Number
48. Have you ever been arrested and/or convicted of a crime?

    1. Yes
    2. No
50. If yes, for what?
52. Where?
53. When?
55. 1. As an applicant for a volunteer position with the City of Billings Police Department, I hereby expressly authorize release of any information you, as a reference, may have concerning me, including information of a confidential or privileged nature. I hereby release any organization, company, institution or person furnishing the information requested. I authorize the use of duplicated copies of this document to serve as the original.
57. 2. For the purpose of in-house security, I consent to a criminal history check and background investigation prior to employment.
59. 3. I certify that the foregoing answers, and all supplement documents, are correct and that false information may result in denial and/or dismissal. If offered a volunteer position, I will abide by the City’s Policies, Practices and Procedures.
61. The City of Billings Police Department reserves the right to refuse services based on objective criteria other than the following: gender, race, religion, sexual orientation, and familial status.
63. Signature*
    By typing your name here, you consent to the above conditions of this application.
64. Date*
    Date
Leave This Blank:


65. 1. Receive an email copy of this form.
66. Email address

    This field is not part of the form submission.

67. Submit

* indicates a required field