Ride-Along Application

We are currently offering Patrol Ride-Alongs on a limited basis, with preference given to those interested in a career in Law Enforcement and/or with the Linn County Sheriff’s Office.

Identification
Name*
First Middle Last
Date of Birth*
MM slash DD slash YYYY
Social Security Number (SSN)*
Driver's License Number*
State of Issue*
Contact Information
Home Address*
Street Address Address Line 2 City State ZIP Code
Mailing Address (if different)
Street Address Address Line 2 City State ZIP Code
Email Address*
Home Phone*
Work Phone
Mobile Phone
Other Names Used
Emergency Contact
Name*
First Last
Phone*
Alternate Phone
Personal References
First Reference
First Middle Last
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Second Reference
First Last
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Additional Information
Current Occupation
Have you ever been arrested for any criminal offense?*
- no
- yes
Please explain the circumstances of your arrest:
Have you applied for an employment position with the LCSO?*
- yes
- no
Reasons for Ride-Along Request*
Please explain why you are requesting permission to ride as a civilian observer in a Sheriff’s Office patrol vehicle.
Choose Days and Times
Please list three choices for days of the week and times of the day during which you would like to ride with a Deputy.
First Choice: Weekday*
First Choice: Shift*
Second Choice: Weekday*
Second Choice: Shift*
Third Choice: Weekday*
Third Choice: Shift*
Signature and Certification
Certification*
I have read, understand, and accept the rules of the LCSO Ride-Along Program.

In addition I have read the entire text of this application and understand it completely. The statements I have made are correct and true.

I understand that making false statements on this application is a crime. If I have made false statements in this application, I am subject to prosecution and my application will automatically be denied or revoked.
- I certify that I intend my electronic signature on this application to be the legally binding equivalent of my traditional handwritten signature.
Signature*
Enter your full legal name.
Date Signed*
MM slash DD slash YYYY
Release and Hold Harmless Agreement
Please read carefully before signing:*
In consideration of being permitted to ride in a vehicle owned and operated by the County, for the expressed purpose of observing operations and facilities of the Sheriff’s Office, the undersigned agrees to release and hold harmless the County, its agents, employees, and elected officials from any and all liability to me for personal injury, death or any property damage, whether proximate or remote, sustained during or as a result of my ride as an observer.

I understand that I will be a guest passenger in the vehicle in which I ride and have not offered any payment to the Sheriff’s Office or its employees for the opportunity to ride.

I further understand that I may be summoned as a witness in any proceeding as a result of my observations. This observation is for my educational benefit. At all times, I agree to obey all orders, instructions and commands of the deputy sheriff of the Sheriff’s Office.

I fully realize and appreciate the basic nature of law enforcement and the possibility that situations may arise which might result in my exposure to danger of physical harm or injury, including traffic accidents, and I am willing to accept these risks. I further agree to keep confidential anything which I may observe or hear. I understand that my observation ride may be terminated at any time without notice.

I authorize the Sheriff’s Office to conduct a complete records check of me prior to riding and understand that nay information of an adverse or criminal nature may disqualify me.

I freely and voluntarily sign this Release and Hold Harmless Agreement in sole reliance of my own independent judgment.
- I certify that I intend my electronic signature on this Release and Hold Harmless Agreement to be the legally binding equivalent of my traditional handwritten signature.
Signature*
Enter your full legal name.
Date Signed*
MM slash DD slash YYYY
Parental Endorsement
Required for applicants under the age of 18
I have read and understand the Release and Hold Harmless Agreement and agree to be bound to its provisions as they apply to my son/daughter named above. I agree to assume full responsibility for my son/daughter as it would pertain to the provisions set forth.
- I certify that I intend my electronic signature on this application to be the legally binding equivalent of my traditional handwritten signature.
Parent/Guardian Signature*
Enter your full legal name.
Date Signed*
MM slash DD slash YYYY
Phone
This field is for validation purposes and should be left unchanged.

Ride-Along Application

Ride-Along Application

Identification

Contact Information

Emergency Contact

Personal References

Additional Information

Choose Days and Times

Signature and Certification

Release and Hold Harmless Agreement

Parental Endorsement