PD-15 (11-17) Virginia Beach Police Department Page 1 of 2
Civilian Volunteer & Intern Application
Jo Ann Weger, Volunteer Resource Manager
Municipal Center, Building #11
2509 Princess Anne Road
Virginia Beach, Virginia 23456
Office: 757.385.4970 / FAX: 757.385.5622 / Email: jweger@vbgov.com
Applicants will require a criminal history background check, fingerprinting, and a photo ID supplied by
the Virginia Beach Police Department. A driving record check is only reviewed when the volunteer
position requires driving a city vehicle.
Convictions of crimes against persons or animals and moral turpitude are automatic disqualifiers.
Application Instructions
This information is for official use by the Virginia Beach Police Department. A police record check will
be conducted on all prospective volunteers or interns with the Virginia Beach Police Department.
Required forms to complete the application process:
Both pages one and two of the Civilian Volunteer & Intern Application (PD-15), and the attached
Criminal Record Information Request (PD-150V) must be completed. Page three (PD-150V) MUST BE
POSITION APPLIED FOR (check only one):
Intern (what school do you attend?)
Volunteer (where do you wish to volunteer?)
1. Legal Name:
Any other Names Used? If Yes, Please List:
Gender: Male Female Date of Birth:
2. Email Address:
3. Address:
State Zip
4. Telephone(s):
(Include Area Code)
Virginia Beach Police Department Page 2 of 2
Civilian Volunteer & Intern Application
5. List all convictions for any criminal offense either as an adult or juvenile. List the county, city or town, state,
charge, charge date, and final disposition of each case:
Criminal Charge
Date Charged
County or City & State
Final Disposition
6. In case of an emergency, provide notification information:
Contact Person
Phone Number(s)
I hereby certify that all statements and answers made are true and complete to the best of my knowledge. I
am aware of the confidentiality of this position. I am also aware that information divulged on confidential
information with the Department of Police could subject me to criminal prosecution.
I hereby authorize the Virginia Beach Police Department, Municipal Center, Virginia Beach, Virginia, to obtain
and review any and all information contained on this application form. I further release any holder of such
information of any and all claims or damages resulting from the same information given.
I hereby give consent and authorize the Virginia Beach Police Department to search their files and Virginia
Central Criminal Records Exchange for any criminal history record.
SIGNATURE: DATE: ____________________
After completing this application (PD-15) and the Criminal Record Information Request (PD-150V),
please return both to the address at the top of page 1 by mail, fax or in person.
Remember that form PD-150V Must Be Notarized.
Please note that the processing of form (PD-150V) may take 2-7 days.
Once both of the aforementioned forms are received and processed, you will be notified by phone
or email on how to obtain your volunteer ID card.
Any questions, please call the contact number at the top of page 1.
PD-150V (0817)
In accordance with Code of Federal Regulations 28CFR20.21, Code of Virginia § 9.1-101, Code of
Virginia § 19.2-389 (1950), as amended, and the Rules and Regulations of the Criminal Justice
Services Commission of the Commonwealth of Virginia.
1. Unauthorized or further dissemination will subject the disseminator to crim
inal and civil penalties.
2. This form will be placed on file and remain on file for at least two (2) years (Code of Virginia).
(Please PRINT on application except for signatures required)
Applicant Information (name searched):
Name ___________________________________________________________________________________________
Last Suffix Full First Name Full Middle Name Maiden
Sex Date of Birth SS# _______________________
Place of Birth
Reason for Request _______________________________________
Current Address __________________________________________________________________________________
Street #/Street Name Apt# City State Zip
Phone ( ______ )__________________________
(Include Area Code)
Applicant Notarization: I hereby give consent and authorize the Virginia Beach Police Department to search
their files and Virginia Central Criminal Records Exchange (CCRE) for any criminal history record and report the
results of such search to the agent or individual authorized in this document to receive same.
Signature of Person Named in Record ________________________________________________________________
Subscribed and sworn to/affirmed before me this ____________ day of __________________________ , 20 ________
Notary Signature
My commission expires _____________________
Requesting Division: As provided for in Section 19.2-389, Code of Virginia, I hereby request the criminal history
record of the individual named in Section I above and swear or affirm that I have the consent of the person to
obtain his/her record and will not further disseminate the information received, except as provided by law.
Signature of Person Making Request _____________________________________________ Date: _________________
Rank/Title Name
___ No Criminal Record
Clerk's Signature: ___________________________Code:________
___ Positive Criminal Record
Date: ____________________
Position (volunteer, college intern, Project Lifesaver, CAC, A/C, other): _______________________________
Approved By: _______________________________ Work Location: ________________________________
ID Printed By: _______________________________ Date: _______________ ID Expiration: ____________
(Return completed form to the VBPD Volunteer Resource Manager’s Office)
Below For Office Use ONLY