Approval StatusPending Review

PHOTO ID REQUIRED (copy will be retained). APPLICANTS MUST BE AT LEAST 14 YEARS OF AGE

NameSeth Richard Gregoire
Cell Phone9712407780
Home Address2455 Hassell Ct NE
Keizer, Oregon 97303
Map It
Date of Birth06/04/1992
SSN #543394962
Driver License Number & State1977830- OREGON
Purpose of Ride

I am a Police officer applicant wanting to see what a shift looks like and meet other officers in the department.

Emergency Contact Information
Emergency Contact NameJordan Gregoire
Emergency Contact Phone5033293623
Date You Want to Ride05/07/2026
Time Requested05:00 PM
Patrol observation rides are a maximum of 5-hour duration. You are limited to 1 ride per calendar year. Please schedule as far in advance (7 DAY MINIMUM) as possible. You will be contacted by telephone to confirm whether or not there is a vacancy for the date and time you have selected. IF SELECTED TO RIDE, YOU ARE BEING REQUESTED TO SHOW UP WEARING CLOTHING DEEMED AS BUSINESS CASUAL.
Ride Rules & Acknowledgements
Consent I agree to the privacy policy.
Are you under 18 years of age?Yes
Applicant SignatureSignature
Date05/01/2026
Parent/Guardian Signature
PD Department Use Only
Records CheckAttach ONLY: Arrest info, Suspect info, Concealed Weapon Permit info, Corrections Client Info
For Officer to Complete