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Name*:

Address*:

Your Email:

Phone Numbers:
Home:
Cell:
Work:

Driver's License #*:
Date of Birth*: U.S. Citizen *:

If currently employed, employer info:

Program of Interest (Hold down Ctrl and click to select multiple programs)*:

For security reasons all applicants are subject to criminal background checks. Please review the release below and type your name to acknowledge you understand this.
By typing my name below, I hereby authorize release to the Bedford County Sheriff's Office, permission to review my criminal background reports as part of the application process for the Homeland Security Volunteer Programs.
Name *:
Date *:

Please verify that you are not a robot: *
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