2. SAN GABRIEL POLICE DEPARTMENT

   POLICE EXPLORER PROGRAM APPLICATION & SCREENING QUESTIONNAIRE

   Instructions: Accurately and honestly complete the entire application. Include all area and zip codes, apartment, and space numbers, if appliable. Any false statement and/or omission of any information of this application will be grounds for disqualification. A criminal background check will be conducted, including a Live-Scan fingerprint process. Submission of this application is not a guarantee of acceptance. Police Explorers are NOT compensated and are NOT considered employees of the SGPD. Police Explorers are youth volunteers and serve at the discretion of the SGPD and its representatives.   

4. Last Name*
5. First Name*
7. Sex*
8. Race*
9. Height *
10. Weight *
12. Hair Color *
13. Eye Color *
14. Date of Birth *
15. Age *
17. California ID Card #*
18. Student ID Card #
20. Email Address *
22. What social media accounts do you own?

    1. Instagram
    2. Twitter
    3. Facebook
    4. Snapchat
    5. Tiktok
    6. Other (please specify)
24. Please provide all of your social media account names (if applicable)
26. Home phone
27. Cell phone
31. BACKGROUND SCREENING INFORMAITON
33. Have you ever been arrested?*

    1. Yes
    2. No
35. If so, when, where and what charge?
37. Are you currently on probation?*

    1. Yes
    2. No
39. If yes, for what charge?
41. Have you ever received a citation?*

    1. Yes
    2. No
43. If yes, when and what charge?
45. Have you ever knowingly used recreational drugs? (Ex. Marijuana, Ecstasy, Bath Salts, etc.)? *

    1. Yes
    2. No
47. If yes, what?
48. When was the last time?
50. Have you ever knowingly (used) prescription drugs not prescribed to you?

    1. Yes
    2. No
52. If yes, what?
53. When was the last time?
55. Have you ever knowingly consumed alcoholic beverages?*

    1. Yes
    2. No
57. If yes, what?
58. When was the last time?
60. Do you have any tattoos?*

    1. Yes
    2. No
62. If yes, who, what is their relation to you, and from what gang?
66. RESIDENCE INFORMATION
68. Address1*
70. City*
71. State*
72. Zip*
74. How long have you been residing here?*
78. Vehicle Information
80. Do you drive an automobile?*

    1. Yes
    2. No
82. Make
83. Model
84. Color
85. License Plate #
87. Vehicle registered to
91. School currently attending
92. City
93. Grade
97. School Last Attended*
98. City
99. Grade
103. Employment Information
105. Current Employer
106. Address
108. Job Title
109. Phone Number
113. Supervisor's Name and Contact
115. Last Employer
116. Address
118. Job Title
119. Phone Number
121. Have you ever been terminated from your job?*

     1. Yes
     2. No
123. If yes, when, from where, and why?
127. Have you ever been an Explorer before?

     1. Yes
     2. No
129. Where/Where?
131. Have you ever been turned down to become an Explorer before?*

     1. Yes
     2. No
133. Where/When
135. If currently enrolled in school, do you have a GPA of 2.0 or higher?*

     1. Yes
     2. No
     3. Not enrolled
137. Can you commit to attending an 18 week basic explorer academy, held every Saturday from 6:30am - 5:00pm?

     1. Yes
     2. No
     3. Schedule Conflict
141. FAMILY
143. Fathers/Guardian's Name
144. Phone
146. Father/Guardian's Occupation
147. Occupation Phone
149. Mother/Guardian's Name:
150. Occupation Phone
152. Sister(s) Name and Age
154. Brother(s) Name and Age
156. Closest Relative Not Living With You
157. Relation to you
159. Address1
161. Address2
163. City
164. State
165. Zip
169. HEALTH
171. Family Physician
173. Address1
175. Address2
177. City
178. State
179. Zip
181. Medical Insurance Co. That Covers You
183. Address1
185. Address2
187. City
188. State
189. Zip
191. Phone Number
192. Policy Number
194. Do you suffer from any medical or physical disorder?

     1. Yes
     2. No
196. If yes, please explain
198. Have you been hospitalized in the last three years?

     1. Yes
     2. No
200. If yes, please explain

204. I attest that the information provided by me is accurate & complete to the best of my knowledge and recollection. I give my authorization to conduct a thorough background check on me (my child), including fingerprint and social media inquiries. I understand that any false information provided by me and/or any omission(s) is grounds for disqualification. 

Leave This Blank:


206. 1. Receive an email copy of this form.
207. Email address

     This field is not part of the form submission.

208. Submit

* indicates a required field