Volunteer Metro Mental Health Co-Responder Application

 
 
 
 
 
 
 
 
 
Please indicate your highest level of education completed
 

 
Are you currently licensed in the State of Utah as one of the following
 

Current or Most Recent Employment [Resume required]

 
Example: From: May 1, 1998 To: Current
 
 
 
 
 
 

References

Please list three professional and/or personal (not relatives) references: Include first & last name, complete home or work address, current phone number, and relationship
 
 
 
 
 
 
 
Have you served in the United States Military Forces? If yes, please submit the DD-214
 
Submit: Resume (required) Form DD-214 (if applicable)
Drop your files here
 
By submitting this application, I hereby authorize the Unified Police Department to perform any or all of the following background histories, criminal, credit, references, employment, identification verification, or any and all information of whatever kind in either written or verbal form, which relates to my ability to perform the duties of the position for which I am applying. I release the Unified Police Department of any liability for the use of this information in considering and reviewing my application. I certify that all statements made in this application are true and complete, and that any misstatement or omission of material facts may subject me to disqualification or dismissal.