ARLINGTON CITIZENS ON PATROL ONLINE APPLICATION
 

All fields are required.
 
Name Information
First Middle Last  
 
 
Address Information
Address City State Zip
 
Contact Information
Phone Work Phone  
 
Email
 
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:

Have you been arrested or convicted of a criminal offense within the last ten years?
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 a criminal history check on me using the information I have provided on this application. "