Volunteer Application Form

NOVA SCOTIA CITIZENS ON PATROL ASSOCIATION

September 2024

*Please note: all forms fields are required.

Name of Applicant:

SURNAME

MAIDEN NAME (if applicable)

Given Name

Middle Name

Preferred Pronouns

Preferred Pronouns (If you selected "Not Listed")

Date & Place of Birth:

D.O.B. Year / Month / Day

YYYY

City, Province, & Country of Birth

Home Address:

Apt No. & Street Address

City/Town

Province

Postal Code

Contact Information:

Home Telephone

Cellular Number

Email Address

Place of Employment:

Name of Business

Supervisor Name

Telephone Number

Driver's License Number:

Province

Expires

Vehicle Information:

Year

Make

Model

Colour

Licence

Province

Next of Kin:

Full Name

Telephone Number

I agree to the below terms and conditions.

1. CONSENT FOR CRIMINAL RECORD / BACKGROUND CHECK

I hereby authorize and give my consent to the RCMP, or my local police service, to make such investigations as they deem necessary to determine the approval or disapproval of this application.

I understand and accept that the RCMP, or my local police service, in concert with my local Citizens On Patrol Society will have the final say in the approval or rejection of this application. Further, I understand and accept that the criteria or method of arriving at such decisions will not be questioned or objected to by me, and that I will have no grievance against the RCMP or my local police service, or my local Citizens On Patrol Society, or the NSCOPA.

2. VOLUNTEER CODE OF CONDUCT

In the interest of my personal freedom from civil and criminal liability, I agree to abide by all of the provisions set out by the NSCOPA and my local Citizens On Patrol Society. And, without restricting the foregoing, I understand that I AM AGREEING TO:

• Act in a professional manner at all times, fulfilling my duties and obligations with integrity and competence;

• Respect the confidentiality of all persons and information within the patrol, community, and local police;

• Use my own transportation and notify my insurance company that I will be participating in Citizen On Patrol and ensure that I am properly covered, should I be involved in an accident;

• Use my Citizens On Patrol identification only when reporting in at checkpoints or when requested to produce it by a member of my local police service;

• Maintain a valid driver’s licence and current registration for my vehicle if I am the driver;

• Never go out on patrol alone;

• Not use any knowledge gained through my service for financial gain or profit;

• Not solicit or accept any gratuities for services provided through the patrol;

• Not take an untrained or unauthorized person on patrol, i.e. family or friends;

• Not carry or use any weapons while on patrol. I will not carry handcuffs, zip ties or other restraint devices;

• Not pursue any vehicle or persons;

• Not be involved in criminal behaviour; and

• Not carry a dog, or any other pet in the vehicle, especially one which may appear as vicious.

I understand and agree that if accepted into the membership of my local Citizens On Patrol Society that the RCMP, or my local police service, or my local Citizens On Patrol Society may terminate my membership at anytime if I do not maintain the membership standards, requirements, or code of conduct. If I am involved in a Federal or Provincial Offence I will immediately inform the Detachment Commander of the area I am volunteering in.

Volunteers agree to:

Conduct 4 hours/month of patrol activity.
Attend the scheduled monthly meetings of their local Citizens On Patrol Society.
Participate in the basic training program provided by the RCMP and the NSCOPA.
Return their Citizens On Patrol identification and all Citizens On Patrol materials in their possession to their local Citizens On Patrol Society upon cessation of their membership.

3. DECLARATION OF CONFIDENTIALITY

I do solemnly declare that I will not disclose to any person outside the RCMP, or my local police Service, any information of which I may gain through my participation with the Citizens On Patrol program without authorization from the RCMP, or my local police service.

4. AGREEMENT TO CONSENT FOR PUBLICATION

I do declare that prior to publishing any article or other material containing information of which I may become possessed through my participation in the Citizens On Patrol program, I will submit same for review by the RCMP, or my local police service, for their approval and consent to publish.

5. WAIVER OF CLAIM

I further agree, being at the age of majority, in consideration of my participation with the Citizens On Patrol program, I hereby absolve and save harmless the RCMP, my local police service, my local Citizens On Patrol Society and the NSCOPA, from all liabilities, causes of action, damages or otherwise for personal injury or loss of or damage to property, however caused, by or resulting from participation in the Citizens On Patrol program.

6. WITNESS AGREEMENT

I fully understand that, as a result of my participation with the RCMP, or my local police service, in this Citizens On Patrol program, I may be required and hereby agree to testify as a witness in future proceedings and that I may also be required and hereby agree to provide a statement and/or a detailed written account of my observations and actions in that regard. I also recognize and hereby agree that these written statements and/or accounts are subject to release to the defence counsel of an accused person where they are relevant to that person's defence in a related criminal proceeding.

7. INSURANCE

I understand that I will be using my own transportation. Upon successful completion of this application, I also understand that it is my responsibility to notify my insurance company that I will be participating in a patrol and ensure that I am properly covered, should I be involved in an accident.

This information will be used by the Nova Scotia Citizens On Patrol Association (hereafter referred to as NSCOPA) to ensure the suitability of candidates for the program. This information may be disclosed to the Royal Canadian Mounted Police (hereafter referred to as RCMP). This information will be protected in compliance with the provisions of the Freedom of Information and Protection of Privacy Act (FOIP) Act. This information will be retained in accordance with approved Records and Information Management policies of the RCMP, while you are a member of Citizens On Patrol; after which it will be destroyed in a secure manner. If you have any questions about the collection and use of this personal information, please contact NSCOPA. Police Personnel completing the above security checks must contact their Security Unit to determine the appropriate level of security clearance required for the program in their area as some programs are more involved than others.