Arlington Police Department - Volunteer Application

ARLINGTON VOLUNTEER ONLINE APPLICATION

For futher processing please include the following fields: First Name, Last Name, Address, City, State, Zip, Phone, Driver's License (and State issued), Date of Birth, Gender, arrested indicator, and the two acknowledgements.

Name Information

First Name:

Middle Name:

Last Name:

Address Information

Address:

City:

State:

Zip Code:

Contact Information

Home Phone Number:

Work Phone Number:

Email Address:

Employer:

Vehicle Insurance Information

Insurance Carrier:

Policy Number:

Expiration Date:

Other Information

Driver's License Number:

State Issued:

Date Of Birth:

Sex:

Race:

Select The Program:

Arlington Clergy and Police Partnership

Citizens Police Academy

Hispanic Citizen Police Academy

Have you been arrested or convicted of a criminal offense within the last ten years?

Please Note: Failure to accurately or truthfully report an arrest(s) for any offense regardless of the conviction results will be cause for immediate rejection of your application.

Yes

If Yes, please briefly explain:

ARLINGTON POLICE DEPARTMENT REQUEST AND AUTHORIZATION OF RELEASE OF INFORMATION

Please read each statement below; check the box to the left to acknowledge your acceptance.

I hereby certify that there are no willful misrepresentations, omissions or falsifications in the foregoing statements and answers. I understand that any omission or false statements on this application shall be sufficient cause to prevent me from participating in the Citizens on Patrol program.

I do hereby request and authorize the Arlington Police Department, Arlington, Texas, to review extracts of information contained in records maintained by the Arlington Police Department of which I am the subject. Said extracts of information shall be limited to:

1. Type of incident
2. Date of incident
3. Charges filed or not filed
1. Court of which charges were filed

I understand by submitting this Volunteer Application I am granting the Arlington Police Department permission to conduct an entry and annual review of my driving history and criminal history check on me using the information I have provided on this application.

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