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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?
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.) YOU ALSO UNDERSTAND THAT THE RICHARDSON POLICE DEPARTMENT WILL NOT HAVE TO DISCLOSE THE REASON, IF ANY, FOR NOT BEING ACCEPTED TO THE PROGRAM.
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