FORT WORTH POLICE DEPARTMENT
CITIZENS ON PATROL APPLICATION
(Fields in red are required)
COPS GROUP NAME:
Park Glen Code Blue Group
Date:
Name:
Race:
Sex:
Male
Female
Date of Birth:
Driver’s License Number:
Home Address:
City:
Zip Code:
Home Phone:
Work Phone:
Work Address:
Occupation:
City:
Zip Code:
Cell Phone:
Email:
Have you ever been arrested or convicted of a crime?
Yes
No
If Yes, explain:
Provide the names, addresses and phone numbers of two references:
Division:
North
South
East
West
Shirt Size:
Small
Medium
Large
X Large
2X
3X
4X
5X
Applicant's Signature:
(you will be required to sign this document if your application is approved)
By submitting this application, I agree to allow the Fort Worth
Police Department to conduct the required checks.
FOR DIVISION USE ONLY
Division: _______________
NPD: __________
NPO: ___________
10-29 Check: __________
SCRAM Check: _______
Criminal History Check: (circle one)
Attached None
X: _______________________________________________
Date: __________________
Signature of NPD Commander / Supervisor approving application