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Pasco Police Department Neighborhood Watch Application Applicant Last Name First Name Middle Name Date of Birth mm/dd/yy Drivers License Number Maiden Name Home address Home phone Work Phone E-Mail Spouse Last Name First Name Middle name Date of Birth mm/dd/yy Drivers license number Maiden name It should be understood that due to the nature of the Block Watch program, applicants should be reliable and trustworthy. For the protection of all concerned, the Pasco Police Department requires the above information. All information contained above is completely confidential. I, the undersigned, hereby authorize the Pasco Police Department to inquire and determine whether or not I have ever been investigated, charged or convicted of a criminal offence. I further authorize the Department to obtain a full and complete disclosure of all the facts uncovered. I have provided the above information for such an inquiry and affirm that I am of good character. This original will be retained by the Pasco Police Department and housed at the local mini-station. The Pasco Police Department reserves the right to revoke Block Watch Status. Applicant Spouse signature: POLICE USE ONLY FORM RECEIVED RECORD CHECK PROCESS COMPLETION LETTER FIRST MEETING ---PAGE BREAK--- Please List all residents, not listed on page 1, in your household, over the age of 12. I the undersigned, authorize the Pasco Police Department to inquire and determine whether or not I have ever been investigated, charged or convicted or a criminal offense. I further authorize the Pasco Police Department to obtain a full and complete disclosure of all facts uncovered. I have provided the following information for such an inquiry and affirm that I am of good character. All information below is completely confidential. Last Name First Name Middle Name Date of Birth (mm/dd/yy) Signature Record Check Last Name First Name Middle Name Date of Birth (mm/dd/yy) Signature Record Check Last Name First Name Middle Name Date of Birth (mm/dd/yy) Signature Record Check Record check: [ ] No Record [ ] Record attached [ ] Approved [ ] Disapproved (Reason) Approved by: