Community Watch Program Introduction Letter and Application – Fairfield County Sheriff’s Office

Name, first middle and last Current street address Current address state Current address zip code Previous address Previous address state Previous address zip code Home phone Cell phone or pager Work phone Driver's license number Driver's license state issued Driver's license date of expiration Email address Neighborhood or township Employer Employer street address Employer state Employer zip code Supervisor Supervisor phone number List all criminal and traffic convictions

Please provide a summary of why you would like to participate in the Community Watch Program Applicant signature Date signed

Date Applicant signature Printed or typed name Day of sworn statement Month of sworn statement year of sworn statement . Notary public My commission expires