Confidential Application Form "*" indicates required fields GENERAL INFORMATIONName* First Middle Last Nickname Spouse's First Name Home Address* Street Address City State / Province / Region ZIP / Postal Code Phone*Email* Employer Position Business Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code PhoneEmail Social Security Number* CA Drivers Lic #* U.S. Citizen* Yes No Place of Birth* Date of Birth* Military Service Yes No Branch Rank Retired Yes No Type of Discharge Membership Rank Requested*Prices for the listed membership levels are for the first year of membership only. They are reduced by 50% for subsequent renewal years. Assistant Sheriff $5,000* INITIATION DONATION WITH FIRST YEARS DUES Dues after the first year $2,500 Commander $2,500* INITIATION DONATION WITH FIRST YEARS DUES Dues after the first year, $1,250 Captain $1,500* INITIATION DONATION WITH FIRST YEARS DUES Dues after the first year, $750 Lieutenant $1,000* INITIATION DONATION WITH FIRST YEARS DUES Dues after the first year, $500 Sergeant $750* INITIATION DONATION WITH FIRST YEARS DUES Dues after the first year, $375 Deputy $500* INITIATION DONATION WITH FIRST YEARS DUES Dues after the first year, $250 Community OrganizationsList any community organization, fraternal organization, service club, or other where you are an active member or past member. Include offices or postions held:Organization / Position HeldOrganization / Position HeldOrganization / Position Held Add RemoveWhy do you want to become a member of the HDSA?:Which HDSA Committee(s) are you interested in supporting (see next page) and briefly describe how you intend to contribute to the HDSA efforts to support law enforcement:Are you interested in serving in a leadership capacity for the HDSA? Yes No REFERENCESPlease list three separate references: In addition to completing this section, please submit a letter of reference from each, including one from your sponsor(s).Sponsor 1 PhoneSponsor 1 type Business Personal Sponsor 2 PhoneSponsor 2 type Business Personal Sponsor 3 PhoneSponsor 3 type Business Personal BACKGROUNDPlease list three separate references: In addition to completing this section, please submit a letter of reference from each, including one from your sponsor(s).As an adult, have you ever been arrested? Yes No When? Where? For what charge(s)? The disposition of arrest? As an adult, have you ever been detained by law enforcement? Yes No When? Where? For what charge(s)? The disposition of situation? As an adult, have you ever been convicted of, or pleaded guilty, or no contest to, a felony or misdemeanor, or are there any criminal charges pending? Yes No If you answered yes to the above question provide a detailed explanation.If you need more space attach a separate sheet.As an adult, have you ever been subjected to collection actions for bad debts? Yes No If you answered yes to the above question provide a detailed explanation.HONORARY DEPUTY SHERIFF’S ASSOCIATION COMMITTEESBelow is a description of the Committees of the HDSA and a brief description of their purpose.Please check the ones you would be most interested in. You will not be asked to serve on all that you check, but you may be asked to serve where you are most needed. A-RANGE: The A-Range Committee is responsible for the maintenance and operation of the Sheriff's Regional Training Center of San Diego County. AWARDS: The Awards Committee is responsible for the creation and obtaining of all awards to be issued to persons designated by the Board. Awards include written awards or commendations as well as crafted mementos or articles suitably appropriate to the achievement. COMMUNITY OUTREACH ASSISTANCE TEAM: (C.O.A.T) is primarily responsible for representing HDSA at community events hosted by or supported by the Sheriff’s Department. Their focus is to raise awareness for HDSA within the community and our mission to support our law enforcement community. FUNDRAISING: The purpose of the Fundraising Committee is to find ways increase HDSA fundraising efforts, apart from annual dues collections to enhance the ability of the Association to fulfill its mission. FUN SHOOT EVENT: The Fun Shoot Event Committee organizes Fun Shoot Events for HDSA members and their guests for the purpose of gaining experience, knowledge and skills on the use of handguns during competition. HAND GUN SAFETY COURSE: The Hand Gun Safety Committee puts together events on Hand Gun Safety training for HDSA members and their guests. INSURANCE: The purpose of the Insurance Committee is to provide oversight and recommendations to the Board regarding building, hazard or liability insurance carried by the HDSA. JURISPRUDENCE: The Jurisprudence Committee's act as attorneys for the Board when outside counsel is not required. Regular attendance at the monthly Board meetings is requested. MEMBERSHIP: The Membership Committee shall work to recruit new members, encourage existing members to upgrade membership, and screen all applicants for membership and to guide new members to help them become . MEMBERSHIP RETENTION & CREDENTIAL RECOVERY: The Purpose of the Membership Retention & Credential Recovery Committee is to contact all members who have not renewed their memberships and encourage them to renew. NOMINATING: The Nominating Committee solicits interest and recruit candidates for the Board of Directors of the Association and submits to the Board of Directors a slate of recommended officers for the ensuing year. PUBLIC RELATIONS: The Public Relations Committee's duties are to make the public aware of the work of the Honorary Deputy in support of local law enforcement, and to promulgate the interests of the Association to the local community and advise the Executive Board on the needs and interests of the law enforcement community. MARKETING / PUBLICATIONS: This committee is primarily responsible for the production of a newsletter or other such publication as may be found reasonable or necessary and distribute such publications to the membership not less than once annually. SHERIFF’S DEPARTMENT LIAISON & LUNCHEON SPEAKERS: The Law Enforcement Liaison Committee’s duties advises the Board on matters pertaining to requests for law enforcement and emergency services equipment funding, and other related matters. REQUEST FOR APPOINTMENT AND AGREEMENTI hereby request appointment by the Sheriff as an Honorary Deputy Sheriff for the specific purposes of maintaining an active membership in the Honorary Deputy Sheriff’s Association (HDSA) and supporting/promoting effective law enforcement for San Diego County and for no other purpose. I agree to maintain active membership in HDSA by promptly paying all dues and assessments upon notice, attending at least half of the general membership meetings held during the year, supporting all HDSA functions and complying with the articles, by-laws, and such policies of HDSA as the Board of Directors may prescribe. I fully understand and agree that my ppointment and membership does not confer any peace officer authority, does not entitle me to carry a concealed weapon, does not entitle me to use my identification card or badge to collect debts, establish credit or attempt to gain any personal advantage whatsoever. I further understand and agree that if appointed, I will at all times conduct myself in a manner which will not reflect adversely upon the Sheriff, his department, the law enforcement professional, or the HDSA. I also fully understand and agree that my appointment can be revoked by the Board of Directors or Sheriff upon good cause. The identification remains the property of the Sheriff and the badge remains the property of the HDSA. I agree that I will surrender either or both upon demand by the Sheriff or the Board of Directors. I hereby grant permission to the Sheriff to conduct an inquiry into my background to determine my suitability for appointment.Signature of Applicant* Date* MM slash DD slash YYYY Signature of Sponsor or Recommender* Date* MM slash DD slash YYYY Full Name of Sponsor* HDSA Badge # I prefer to be contacted by:(choose one) email (home) email (work) USPS mail (home address) USPS mail (work address) Three letters of recommendation, including one from the sponsor, are attached.* Yes No Send this completed application along with: *** Three (3) letters of recommendation, including one from my sponsor, and *** A copy of a valid California Driver’s License are attached. If mailing: Send to the Honorary Deputy Sheriff’s Association, PO Box 421260, San Diego, CA 92142. You will be sent an acknowledgement email once all the materials have been received and again when a decision has been madeLetter of Recmmendation 1Max. file size: 50 MB.Letter of Recmmendation 2Max. file size: 50 MB.Letter of Recmmendation 3Max. file size: 50 MB.Drivers License Upload*Max. file size: 50 MB.please upload / attach a copy of your drivers licenseAdditional Documents (optional)Max. file size: 50 MB.
