Atlanta Reserve Police Program Application

Retiree’s Printed Name
Retiree’s Mailing Address
City	State	Zip Code

( ) -	( ) -	- -
Home Telephone	Alternate Contact Number	Social Security Number	Race	Gender

Date of Birth	APD Unique ID Number	Date Hired by APD	Date retired from APD

Rank at the time of retirement
Duty Assignment at the time of retirement
E-mail Address

In order to make the best possible use of your volunteer effort, we will work to accommodate your preference of assignment. Please indicate the worksite where you would prefer to complete your volunteer service. Please number your top three choices.

Zone One
Communications
Zone Two
Headquarters building
Zone Three
Property Management
Zone Four
Special Operations Section
Zone Five
Training Academy
Zone Six
No Preference

I would like to be considered for membership in the Atlanta Reserve Police Program. I understand that in order to keep my POST certification current, I must attend and successfully complete the annual in-service training at the Atlanta Police Academy. I understand that to keep my arrest powers through the City of Atlanta, I must maintain membership in the Reserve and abide by APD.SOP.1.13 and other Department directives. In return for my in-service training, I agree to give back to the Atlanta Police Department the volunteer hours required by APD.SOP.1.13 each year.

Retiree’s Signature	Date of Application
I.T. Certified	Weapons Expert	Computer Skills	Language Skills	Other critical skills

Form APD-216 Revised 10/16/03

ATLANTA POLICE DEPARTMENT

Richard Clarke

2005-10-26

Ned Cole