Public Safety Application
Personal Information
Family / Household
Residence History
Education History
Military Service History
Employment History
Personal References
Criminal History
Illegal Drugs
Driving History
Backgroud Affirmation
Personal Information
First Name
Middle Name
Last Name
List any other name(s) you have been known by including previous marriages, name changes, and nicknames.
Current Residence
Street
Apartment Number
City
State
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AR
CA
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ID
IL
IN
IA
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MT
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NH
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TN
TX
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Zip Code
Contact Info
Home Phone Number
Work Phone Number
Cell Phone Number
Email address
Personal Info
City of Birth
State of Birth
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AL
AK
AZ
AR
CA
CO
CT
DE
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
Date of Birth
Social Security Number
Scars/Marks/Tattoos (indicate location on body)
Height
Weight
Age
Sex
Hair Color
Eye Color
Race
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American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or Other Pacific Islander
White
Hispanic or Latino
Other
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Citizenship
Are you a U.S. citizen?
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