MSP Ride Along Request Form

Date*

Date

First name*

Middle name*

Last name*

Date of birth (you must be at least 18 years old)*

Date

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone number*

Please enter a valid phone number.

Email*

example@example.com

Name of college or university attending or graduated from*

City*

State*

Major field(s) of study*

Date of graduation (Est. date if applicable)

Date

Branch of military service (if applicable)

Provide a paragraph on why you are interested in going on a ride along and what you hope to learn:*

District/area of preference for ride along*

Preferred time of day*

MorningsAfternoonEveningsOvernights

Special requests

By submitting this request to our agency for review, you agree that:
You have read and understand the MSP Ride Along Program Informational Sheet.
You have reviewed the automatic disqualifiers for this program and are eligible to go on a ride-a-long.
You understand that granting this request for a ride along is at the discretion of the agency. Once assigned, the trooper may deny the request or cut short a ride along in progress for any reason.

To complete your MSP Ride Along Request, submit this form along with the MN DPS Driver’s License/Criminal History Form by using the submit button below. Please contact the Training and Development Section at 651-757-1900 with questions.

The Department of Public Safety requests the following information in order to determine if you have been convicted of crimes, which directly relate to the position you seek with the Department of Public Safety. The requested information is a continuation of the application process pursuant to Minnesota Statute. Your signature on this form authorizes the Department of Public Safety to request a search of your record for any driver license and criminal history.

While you are not required to provide this information, failure to do so may result in removing your name from consideration. The information requested below is private data by law. Your name, including any previous names and your date of birth are necessary to accurately access criminal history information. Although optional, you are requested to provide your gender and race/ethnicity to ensure that the records received are yours. Access to this information will be limited to individuals within the Department of Public Safety whose job duties reasonably require access and to any individuals to whom you provide written consent. Additionally, access to this information will be released without your consent as follows:

to the Commissioner of Minnesota Management and Budget (Minn. Stat. Ch. 43A);
to labor organizations, to the extent necessary to implement state law governing labor relations (Minn. Stat. §13.43);
if required by court order; or
authorized by other state or federal law.

Please provide us with the information requested below.

First name*

Middle name*

Last name*

List previous names used

Date of birth*

Date

Gender*

MaleFemale

Race/Ethnicity*

Have you been convicted of a felony, gross misdemeanor, or misdemeanors for which a jail sentence*

YesNo

Have you been convicted of a felony, gross misdemeanor, or misdemeanors for which a jail sentence*

may have been imposed? Yesno

If yes, please provide a complete chronology of your offense history. Include the type of offense, county, state, date and final disposition (i.e. jail time, fine, probation, etc. ).

Driver license number*

State of issue*

Signature

Please verify that you are human*

Driver License/Criminal History Form