Fillable LONGVIEW POLICE DEPARTMENT CITIZENS ON PATROL (City of Longview)

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LONGVIEW POLICE DEPARTMENT CITIZENS ON PATROL (City of Longview)

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File type: PDF

U.S.A. forms for City of Longview

BROWSE CITY OF LONGVIEW (TX) FORMS

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REV. 11/04/2015
Minimum Age for Enrollment is 21 Years
Personal Information
Full
Name:
Last First M.I.
Address:
Street Address Apartment/Unit #
City State ZIP Code
Home
Phone:
Alternate
Phone:
E-mail
Address:
Driver’s License
Number:
State:
Birth
Date: Sex: Race:
Are you a resident of
the City of Longview?
Are you an employee of the
City Longview? If yes, where:
Employer: Address
Emergency Contact Information
Full
Name:
Last First M.I.
Street Address:
Apartment/Unit #
City State ZIP Code
Primary
Phone:
Alternate
Phone:
Relationship:
Additional Information
Have you graduated from the
Longview Police Academy?
If yes,
when?
How did you learn about
“Citizens On Patrol”?
List (3) personal references: Name Address Phone
1)
2)
3)
Mail your completed application
to:
Longview Police Department
Citizens On Patrol
C/O
Officer Brandon Thornton
P.O. Bo
x 1952
Longview, TX 75606
For Additional Information:
Call the Longview Police Department
Monday through Friday, between
8:00 AM and 5:00 PM at
903-
247-3024
Or
ganization Use Only.
Application received: ____________
Reviewed by:
____________________Date: __________
Approved Disapproved
LONGVIEW POLICE DEPARTMENT
CITIZENS ON PATROL
Print Form
REV. 11/04/2015
LONGVIEW POLICE DEPARTMENT
CITIZENS ON PATROL
AUTHORIZATION TO RELEASE INFORMATION
I hereby request and authorize you to furnish the City of Longview Police
Department with any and all information they may request concerning my
work record, education history, military history, financial status, criminal
record, general reputation, and past or present medical conditions. This
authorization is specifically intended to include any and all information of a
confidential or privileged nature as well as photocopies of such documents,
if requested. The information will be used for the purpose of determining
my eligibility for volunteer service with the City of Longview Police
Department, Longview, Texas.
I hereby release you and your organization from any liability, which may or
could result from furnishing the information requested above or from any
subsequent use of such information in determining my qualification to serve
as a volunteer of the City of Longview, Texas.
APPLICANT’S
SIGNATURE __________________________________________ DATE ________
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LONGVIEW POLICE DEPARTMENT CITIZENS ON PATROL (City of Longview)

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Completed 3 August 2020

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