Shmira Application
This is the general application for Los Angeles Shmira Civilian Safety Patrol. Please answer all questions truthfully.
Email address *
Name (First M. Last) *
Date of Birth *
Drivers License or ID Number *
Vehicle Insurance provider *
Insurance Policy Number *
Email Address *
Street Address *
Home Number *
Cell Number *
Occupation *
Name of Workplace or School *
How did you hear about LA Shmira? *
Why do you want to be a member of Shmira? *
What Programs are you interested in? *
Do you have any specialized skills, certifications, hobbies or interests? *
What is your Highest level of education? *
Do you Speak a foreign language (if so, which?) *
Have you ever been a member of Shmira or Shomrim in L.A. or elsewhere? *
If yes, explain when, where and reasons for leaving
Answering yes to the following questions may not necessarily disqualify you from membership.
have you ever been convicted of a criminal offence other then a minor traffic infraction? *
Are you applying for the purpose of news or intelligence, investigative or research work? *
Do you have any medical conditions that could possibly interfere with your ability to maintain mental alertness, or participate in strenuous physical exercises? *
Please list 3 references (No immediate family members)
Please list one reference in each of the following 3 fields. Please list the full name (First, middle initial and last name, a phone number and email address for each reference as well as what your relationship to the reference is.
First Reference *
Second Reference *
Third Reference *
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