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SALMON ARM CITIZENS PATROL
Application Form
Surname:
____________________________ Given Names:
________________________________________
Date of Birth: Y_____
M_____D_____ Sex:
M___F___ Marital
Status: _________________________
Address:
_____________________________________________________________Postal
Code:__________
(Mailing Address if different from
above:)_______________________________________________________
Phone: Hm:_______________ Wk: ________________
Cell:________________ email __________________
Driver’s License #___________________ or
British Columbia Identification (B.C. ID) #
__________________
Places lived in past 10 years: (Place names &
dates)
________________________________________________
_________________________________________________________________________________________
Occupation & place of
employment:______________________________________________________________
Criminal convictions in past 10 years? (other than
traffic tickets): Yes:____
No:_____ If yes specify what type
of
charges convicted of and
where:__________________________________________________________________
Spouse Information: (Required if living
common-law or married)
Surname:_____________________ Given Names:
_______________________Date of birth
Y______M___D___
Spouse’s maiden
Name:___________________
Address:____________________________________________
Places lived in past 10
years:_____________________________________________________________________
Children: names, dates of birth, addresses (use back
of page if necessary)
1.)
________________________________________________________________________Y_____M___D___
2.)
________________________________________________________________________
Y_____M___D___
3.)
_______________________________________________________________________
Y_____M___D___
Names and phone numbers of two references (Do not
use relatives’ names):
1.)
Name:____________________________
Place of
work_________________________
Phone #
_________________ Cell phone #
_____________
2.)
Name:____________________________
Place of
work_________________________
Phone #
_______________
Cell phone # _____________
How did you hear about SACP?
__________________________________________________________________
I hereby authorize the Salmon Arm RCMP to make such
investigations as they deem necessary to determine
the approval or disapproval of this application and
if necessary to revoke the approval for cause.
I understand that the information gathered by the
Salmon Arm RCMP will be held in confidence.
Signed:________________________________
Dated: Y____ M____ D _____
PLEASE ATTACH A PHOTOCOPY OF YOUR DRIVER’S LICENSE
OR B.C. ID CARD
(February 2017)