CITIZENS ON PATROL APPLICATION

Personal

Name:________________________________________ D.O.B._____________________

Address:______________________________________ Telephone # _________________

Work Telephone # ________________Drivers License #__________________State _____

Do you reside in the City Of Grand Prairie? Yes / No      
Number of years in G.P. _______

Do you own a business in Grand Prairie?     Yes / No      
How long? __________________

If so, Name and Address of business:___________________________________________

                                                           ___________________________________________

Education

High School Graduate?__________ GED__________

Highest Grade Completed_________

Name and Address of High School____________________________________________

College Graduate? ________________ Degree and Major _________________________

Name and Address of College: _______________________________________________
 

Background

Please explain briefly why you wish to be enrolled in the Citizens On Patrol Program.

_________________________________________________________________________

_________________________________________________________________________

List associations, clubs, affiliations, etc. _________________________________________________________________________

_________________________________________________________________________

Have you ever been arrested for, convicted of or cited for any offense other than traffic fines of $200.00 or less:
Y / N (circle one) If yes, explain in detail showing date, charge, place and action taken.

__________________________________________________________________________

__________________________________________________________________________

Employment

Presently Employed ______________________ Yes / No     Work Hours ____________

Name of Employer ________________________________________________________

Position and Duties: _______________________________________________________

________________________________________________________________________

References

List two immediate family members or close friends that we can contact in the event of an emergency.

Name:_____________________________________      Relationship ______________

Address: ___________________________________      Phone: __________________
 

Name:_____________________________________       Relationship ______________

Address: ___________________________________       Phone: __________________

 Medical History

The following medical information is needed in the event of an emergency. List any medications you are currently taking and the condition for which they are used: _______

_________________________________________________________________________

_________________________________________________________________________

Is there any any other medical information that you feel the Grand Prairie Police Department should be aware of ?

________________________________________________________________________

________________________________________________________________________

I hereby certify that there are no willful misrepresentations, omissions or falsifications in the foregoing statements and answers to questions. I understand that any omission or false statements on this application shall be sufficient cause for rejection for enrollment or dismissal from the Citizens On Patrol Program.

I fully understand that Citizens On Patrol is a non confrontational patrol program. It's purpose is to reduce crime through cooperation with the Police Department. Volunteers are trained how to observe suspicious and / or criminal activity in the neighborhood and report it to the police. I acknowledge as a part of acceptance to this program  I will be required to:

1. Attend all training classes and future meetings of the Citizens On Patrol, after
    being duly notified of such meetings.
2. Abide by all rules and regulations set forth by the Police Dept. and The City
    of Grand Prairie.
3. Provide my own transportation and insurance.

I further understand that the Grand Prairie Police Department will be conducting a background investigation that may include, but will not be limited to, fingerprinting, any criminal history and personal references.

Applicant Signature:_______________________________     Date:____________

SEND APPLICATION TO:

OFFICER GREG NEW
801 CONOVER DR.
GRAND PRAIRIE,TEXAS 75051