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BLOCK WATCH REPRESENTATIVE APPLICATION
SPOKANE C.O.P.S BLOCK WATCH REPRESENTATIVE APPLICATION
If you would like to download and print the application please
click here.
Are you 18 years old?
Yes
No
Please indicate which C.O.P.S. shop you are applying for:*
East Central- 2116 E 1st Ave.
Logan- 2927 N Perry St.
Newtech-4141 N Regal St.
Neva-wood 4705 N Addison St.
North Central- 806 W Knox Ave.
Northeast- 5124 N Market St.
Northwest 2215 W Wellesley Ave.
Southeast- 2809 E 29th Ave.
Southwest- 1403 W 3rd Ave.
West- 1901 W Boone Ave.
NOP
Paws on Patrol
Off Road Patrol
Mounted Patrol
First Name*
Middle Initial*
Last Name*
Maiden Name/ Alias (First Name)
Maiden Name/ Alias (Middle Initial)
Maiden Name/ Alias (Last Name)
Address*
City*
State*
Zip Code*
Email*
Phone*
Date of Birth*
How long at present address?*
If less than 1 year, give previous address:
State where born:*
Other states lived in:
Drivers Licenser Number or State ID Number*
Has your license ever been revoked or suspended?*
Yes
No
If yes, please provide the date
Have you ever been convicted of a crime in a court of law, civilian or military?*
Yes
No
If yes, please explain:
Current Employer
Work Phone Number
Person to notify in case of Emergency/ Phone number*
Relationship to you (Spouse, Relative, Friend)*
Full Legal Name (Please list everyone over 18 that lives in your household):
Date of Birth
Full Legal Name (Please list everyone over 18 that lives in your household):
Date of Birth
Full Legal Name (Please list everyone over 18 that lives in your household):
Date
Full Legal Name (Please list everyone over 18 that lives in your household):
Date
Full Legal Name (Please list everyone over 18 that lives in your household):
Date
How did you hear about Spokane C.O.P.S. Block Watch program?*
List any organizations of which you are a member:
Are you or any member of your household currently involved in any neighborhood disputes that may have to be mediated by police?*
Yes
No
If yes, please explain:
Are you or any member of your household the subject of a criminal investigation being conducted by any law enforcement agency?*
Yes
No
If yes, please explain:
Would you have any problem with or providing service to any person because of race, religion, culture or sexual orientation?*
Yes
No
If yes, please explain:
Are you a member of any organization that advocates the overthrow of the US Government?*
Yes
No
If yes, please explain:
Reference 1 Name:*
Phone
Address
City
State
Zip Code
Email
Reference 2 Name:*
Phone
Address
City
State
Zip Code
Email
Reference 3 Name:*
Phone
Address
City
State
Zip Code
Email
As an applicant to be a Spokane C.O.P.S.S Block Watch representative, I hereby authorize Washington Law Enforcement agencies to conduct a background investigation to determine the qualifications of all household members, age 18 years and older, to participate in this program. I understand that such a background investigation is being conducted solely to make sure adult members of the household of the Block Watch representative are law-abiding citizens and are cleared for providing such services. All information is to remain confidential as required by state and federal law.
I Understand
Date
Thank you for contacting us.
We will get back to you as soon as possible.
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Please try again later.
HOME
CONTACT
LOCATIONS
ABOUT US
IN THE NEWS
VOLUNTEER
VOLUNTEER APPLICATION
BLOCK WATCH REPRESENTATIVE APPLICATION
PROGRAMS
Neighborhood Observation Patrol
Paws on Patrol
Latent Fingerprinting
Operation Family ID
Bicycle Registration
Code Enforcement
Crime Free Rental Properties Program
Block Watch
Business Watch
Property Drop Off
Identity Theft
Operation ID
EVENTS
RESOURCES
FAQ
DONATE
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North Ash Street, Spokane, WA 99205 | (509) 625-3300.
Questions, problems or suggestions about this site? Please contact the Webmaster at (509) 625-3300.
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