Washington County Fraternal Order of Police

Petition for Membership and Initiation

Associate Lodge # 40

P.O. Box 82 www.RIFOPA.org

Charlestown, Rhode Island

02813

“It is the goal of this organization to be formed for the purpose of increasing our understanding of the rights, duties, and problems of Police Officers in our society today. We must try and foster public respect for them; bettering the conditions under which they serve; as well as promoting their interests and welfare in every conceivable way. Above all, we must be ready to render such Lawful assistance as may be required by the Fraternal Order of Police or any of its subordinate Lodges.”

Monetary Responsibilities

There is a NON-refundable application fee of $ 30.00. In addition, this application should be submitted with an additional $ 30.00, your annual dues. This is your initial first year dues that are payable up front of $ 30.00. This fee is applicable to everyone; no matter what time of year they are voted in and accepted. If an applicant is not accepted the secretary will notify them in writing and the $30.00 annual dues will be returned. Annual dues are DUE no later than 31 January of the year for which you are renewing. Failure to remit dues in a timely fashion or at least respond to the Treasurer will leave that member ‘not in good standing’. After ninety (90) days of being in arrears of the FOPA, said member will be suspended from the Associate Lodge and his license plate emblem and active membership card shall be recovered.

‘Marks’ of the Fraternal Order of Police

A graduated membership is also in effect regarding the ‘marks’ of the FOP/FOPA:

Acceptance: membership card and windshield decal provided

After three (3) additional meetings attended: license plate tag

After one (1) year membership: FOPA membership patch and lapel pin

Application:

Are you a citizen of the United States of America? ___________________

Naturalized citizen? ____________________________________________________

Do you or have you in the past, voluntarily entered into or organized, ANY event(s) aimed at the overthrow of, the interruption of, or attack of the United States Government, its Allies, Embassies, Armed Forces, or Local Law Enforcement Agencies here in the Homeland or Abroad? Y N

Do you believe in a Democratic way of life with Freedoms for life, liberty, property and the pursuit of happiness? ___________________________________________________

Bill of Rights of the United States Constitution? _________________________________

Pledge of Allegiance? _____________________________________________________

Attention Applicant: Be advised that answering ‘NO’ to the above question(s) does not have a direct bearing on acceptance and/or admittance to this organization.

Personal Information:

Date of this Application: ___________ _______SSN#: _________________________

Name: _________________________________DOB: _________________________

Address: ______________________________________________________________

Mailing Address (if different from above): ___________________________________

City, State, and Zip code: ________________________________________________

Phone: ______________________________ Cell Phone: _______________________

Email: _____________________________________________________________

Employment Information:

1.) Current Employer: __________________ Occupation: _______________

Address: ____________________________________________________________

City, State, and Zip code: _______________________________________________

Phone: _____________________________________________________________

Email: _____________________________________________________________

Years Employed: _________

May we inquire of your current employer? ________________________________

Law Enforcement Experience:

Are you now or have you ever been a member of any Law Enforcement agency? Y N

Agency: ______________________________________________________

Position held: __________________________________________________

Rank: ________________________________________________________

Address: ______________________________________________________

Armed Forces Service:

Have you ever served in the United States Armed Forces or any of its Allies? Y N

Branch: _________________________________________________________

Unit and/or M.O.S.: _______________________________________________

Campaigns fought in: ______________________________________________

Discharge Date: __________________________________________________

Type of Discharge: ________________________________________________

Criminal Record:

Have you ever plead guilty to or been convicted of a Felony? Y N

If yes, state the nature of the crime(s), arresting agency(s), and the state(s) where the offense occurred ____________________________________________________________________________________________________________________________________________________________________________________

Has your driver’s license ever been suspended for speeding or any other moving violation? Y N

If yes, state the reason(s) and length of suspension: __________________________________________________________________________________________

Driver’s License Number and State: ________________Vehicle Registration and Type: __________________

ATTENTION Applicant: Be advised that prior to your final acceptance in the WCFOPA a BCI check will be conducted and the above questions will be verified.

Briefly, why do you seek membership in this Order, the Washington County Fraternal Order of Police, and Associate Lodge # 40? :

____________________________________________________________________________________________________________________________________________________________________________________

Civic Organizations:

Do you or have you in the past belong(ed) to, any civic organization(s)? (i.e. - Elks, Lions, VFW, etc.): ___________________________________________________________________________________

Have you or do you now hold an Office in those organizations? Y N

Office held: ______________________________________________________________

Applicant Affirmation:

I, _______________________, agree if accepted and voted in as a member, to abide by ALL laws, whether Federal or State. I also agree to abide by the By-Laws, rules, and regulations set forth by the FOPA. It is understood and hence agreed thereupon that the decals, membership cards, and license plate emblems are the express property of the FOPA. I agree to return them within ten (10) days of an official request of the Lodge.

In order to be voted upon, the applicant individual seeking membership must be present with the person who is sponsoring them any FOP/FOPA member in good standing at the meeting in which their application shall be voted on. The secretary will notify the applicant in writing of the time, date and place of the meeting at which their application will be presented to the membership thirty days prior.

It is also understood that failure to return the aforementioned items requested by the Lodge, will result in the FOPA notifying the Charlestown Police Department, and the Fraternal Order of Police Lodge # 40. The number obtained from the license plate emblem may be entered into the National Crime Information Center (NCIC) computer as stolen property with the person’s name who had the last issue, meaning, YOU, the member.

I also, hereby, affirm and certify that to the best of my knowledge the answers given forth on this document are true and correct, and verifiable upon request. I understand and accept the rules, terms, and conditions of this application. I agree to attend a minimum of three (3) meetings per calendar year and at least one (1) special event per calendar year, i.e.- fundraiser, golf tournament, etc., as stated in the By-Laws and Constitution of the FOPA (Article 2, Sec 11).

By signing below, I further agree to NOT hold the FOPA, Charlestown Police Dept. FOP Lodge # 40, the State Lodge of the Fraternal Order of Police, or the National Fraternal Order of Police or any of its members responsible in ANY way for ANY and ALL problems arising from having my application rejected; whether by reason of a negative BCI, NCIC, DMV report or negative recommendation from references.

Lastly, I hereby, agree to allow the Town of Charlestown’s Police Department to perform a complete criminal background check on me.

Signature, time and date of applicant: ___________________________________________________

FOP/FOPA Sponsor: ________________________________________________________________