Please enable JavaScript in your browser to complete this form.Basic InformationName *FirstLastDate of Birth *Address *Address Line 1CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodePhone *Email *Driver's License Number *Why do you want to participate in this program? *Have you participated in our "RIDE-A-LONG program" in the past? *YesNoPast Ride A Long Participation DateHave you ever been arrested? *YesNoIf "Yes" explain:PLEASE GIVE TWO WEEKS ADVANCE NOTICE FOR PROCESSING Available Shifts: Days: 0600-1600, 0800-1800 Swing: 1500-0100 Graves: 2100-0700 Shift Preference *Days 0600-1600Days 0800-1800Swing 1500-0100Graves 2100-0700Date Preference *Medical History High Blood Pressure *YesNoHeart Condition *YesNoNervous or Mental Condition *YesNoSerious Mental Condition *YesNo Dress code: Ride-a-longs shall be required to be neatly dressed in casual business attire. Applicants must be 18 years of age or older at the time the application is submitted. Exceptions are made with the Captains consent and parent or legal guardian if applicable. All participants must sign an accident waiver before they will be allowed to ride, including parent or guardian if applicant is under 18. All applicants must be able to promptly follow the verbal instructions of the host deputy, enter and exit the patrol car unassisted, and to take evasive action in an emergency. All applicants must meet one or more of the criteria below (check all that apply) *Resident of San Joaquin countyVisiting law enforcement personnel from other agencyStudent of San Joaquin county high school and in possession of valid student body cardSan Joaquin county employee and immediate familyAny valid news media representativeCurrent criminal justice program student (list academic institution)Other (please specify)Current criminal justice program academic institutionOther (please specify)AGREEMENT ASSUMING RISK OF INJURY OR DAMAGE WAIVER AND RELEASE OF CLAIMThe undersigned has requested permission to ride as a guest/observer in a San Joaquin Sheriff Department vehicle and accompany a member or members of the department during the active performance of their official duties as Deputy Sheriffs (initial) *I, the undersigned, acknowledge that the work and activities of the department in connection with the ride-a-long are inherently dangerous to me, possibly involving risk of personal injury, death, damage, expense, or loss to person or property (initial) *I, the undersigned, hereby releases the County of San Joaquin, the San Joaquin Sheriff's Office, its employess and/or agents, the driver or owner of any automobile owned or operated by or in the service of the County of San Joaquin, their sureties, and each of them, from liability or responsibility under any circumstances whatsoever, and by name by the undersigned, his or her estate or heirs, for any injury, death, damage, expense, or loss to the person or property of the undersigned, incurred while riding as a guest/observer in any vehicle, or while accompanying a member of said department during the active performance of his or her official duties as a peace officer (initial) *I, the undersigned applicant declares under penalty of perjury that all of the information that I have given in the foregoing application is correct, and that I have read and understand the herein above agreement assuming risk of injury or damage, waiver and release of claims: and that I knowingly and willingly assume the risk of any loss, death, damageof any kind whatsoever, which I may incur as a result of participating in the "ride-a-long" program. Applicant Signature * Clear Signature Parent/Legal Guardian *Emergency Contact *Emergency Contact Phone *Submit