2. NAME: LAST, FIRST MIDDLE
4. ADDRESS (IF CITIZEN OF CEDAR HILL, PLEASE LIST HOME ADDRESS. IF YOU ARE EMPLOYED IN CEDAR HILL, LIST BUSINESS ADDRESS)
6. ADDRESS2
8. CITY
9. STATE
10. ZIP
12. HOME PHONE NUMBER
13. WORK PHONE NUMBER
14. CELL PHONE NUMBER
16. EMAIL ADDRESS
17. DATE OF BIRTH
19. TEXAS DL OR ID NUMBER
20. GENDER
21. RACE
23. HAVE YOU BEEN CONVICTED OF A FELONY OR CLASS B MISDEMEANOR AND ABOVE?
25. ARE YOU CURRENTLY INVOLVED IN A CRIMINAL INVESTIGATION? IF YES, PLEASE EXPLAIN.
27. Electronic Signature Agreement

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
29. Electronic Signature
30. Print Name, Rank/Title
32. DATE AND TIME
    DATE AND TIME

    DATE AND TIME
Leave This Blank:


34. 1. Receive an email copy of this form.
35. Email address

    This field is not part of the form submission.

36. Submit

* indicates a required field