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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