City of Richardson, TX : Form/Survey

Survey/Form Review

Crime Watch Patrol Application

Name of Crime Watch Patrol:

Your Name:

Race:

Sex:

Maiden Name:

Other Names Used:

Date of Birth (Please enter in this format, MM/DD/YYYY):

Texas Driver's License Number:

Home Address:

Home Phone:

Work Phone:

Email Address (For you to receive CWP news/alerts):

Emergency Contact Information

Emergency Contact's Name:

Emergency Contact Address:

Emergency Contact Phone:

REFRENCES

1st Reference's Name:

1st Reference's Address:

1st Reference's Phone:

2nd Reference's Name:

2nd Reference's Address:

2nd Reference's Phone:

Have you been arrested?

Yes

If you answered "yes" to being arrested, please provide short explanation:

What other states have you lived in?

BY SUBMITTING THIS APPLICATION, YOU CERTIFY THAT YOU UNDERSTAND AND GIVE YOUR FULL CONSENT TO THE RICHARDSON POLICE DEPARTMENT TO CONDUCT A CRIMINAL HISTORY CHECK. YOU FURTHER UNDERSTAND THAT YOUR CHARACTER REFERENCES MAY ALSO BE CHECKED. (THIS INFORMATION WILL BE KEPT CONFIDENTIAL AND IS NOT RELEASABLE TO THE PUBLIC.)

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