ARLINGTON CITIZENS ON PATROL 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 Middle Last  
 
 
Address Information
Address City State Zip
 
Contact Information
Phone Work Phone  
 
Email
Employer
 
Vehicle Insurance Information
Insurance Carrier
Policy # Expiration Date  
 
 
Other Information
Driver's License #

State Issued
Date of Birth    
Sex Male     Female
Race
Black
White
Hispanic
Asian
Other
 
       
Name of the Community Watch Group you are currently an active member of, or volunteer member of another City sponsored program (Code Rangers, CPA, C.E.R.T., Neighborhood Summit).:

Required Field.


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.
No     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
4. Court to which charges were filed

" I understand by submitting this C.O.P. application I am granting the Arlington Police Department permission to conduct an entry and annual criminal history check on me using the information provided on this application. "