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2. Last Name*

   Enter Your Last Name

3. First Name*

   Enter Your First Name

4. Middle Name*

   Enter Your Middle Name

6. Street Address*

   Enter Your Street Address

7. City*

   Enter Your City

8. State*

   Enter Your State

9. Zip Code*

   Enter Your Zip Code

11. Phone Number*

    Enter Your Phone Number

12. Date of Birth*
    Date of Birth

    Enter Your Date of Birth with the following format:

    MM/DD/YYYY

13. Sex*

    Enter Your Sex

14. Race*

    Enter Your Race

16. Email Address

    Enter Your Email Address

18. Background Authorization

    I understand that a criminal history check and a warrant check will be conducted as part of the application process. I hereby authorize any law enforcement agency, agencies of the government of the United States of America, and agencies of the State of Ohio to release to the Bowling Green Police Division any and all information, which said agencies have about me, for the limited purpose of aiding the Bowling Green Police Division in evaluating my eligibility for participation in the Citizen Outreach Program.

    
    

    This release extends to any and all information, which said agencies have about me, whether public, personal, or confidential. I understand that I will not receive and am not entitled to know the contents of confidential reports received from these agencies, their agents and representatives.  Any person furnishing information shall be released from any liability of every nature arising out of the furnishing and inspecting of such documents, records, and other information, and this release shall be binding on my legal representatives, heirs and assigns.

    
    

    A representative of the Bowling Green Police Division will contact you to complete the necessary information needed for the background check. 

    
    

20. Agreement*

    1. Yes

    I agree to the above Background Authorization

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22. 1. Receive an email copy of this form.
23. Email address

    This field is not part of the form submission.

24. Submit

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