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2. Authorization*

   I UNDERSTAND, AUTHORIZE AND GIVE PERMISSION for the City of Texas City Police Department to conduct an investigation of my criminal history, driving record, and other job-related investigation as necessary to determine my qualifications.

   
   

   1. I AGREE
3. 
5. Notice

   A waiver of liability and hold harmless agreement will provided by the explorers program manager upon application submittal and will be required for participation.

9. Applicant Information
11. First Name*
12. Date of Birth*
    Date of Birth
14. Middle Name
15. Texas Drivers License / Texas ID #
17. Last Name*
19. Home Address*
21. City*
22. State*
23. Zip Code*
25. Phone Number*
26. Email Address*
30. Current Grade Level*
31. Graduating Year*
33. School Name*
34. School District Name*
36. School Address*
38. School City*
39. School State*
40. School Zip Code*
44. Have you ever been arrested for an offense other than a traffic violation?*

    1. Yes
    2. No
45. If yes, please state when, where and the circumstances)
49. Describe in your own wors why you want to be in the Texas City Explorer Program.*
51. Career Interests / Choices
53. #1*
54. #2*
55. #3*
57. Uniform Sizes
59. Shirt Size (Gender Specific)*

    1. Small
    2. Medium
    3. Large
    4. X-Large
    5. XX-Large
60. Pants Waist*
61. Pants Length/Inseam*
65. Parental / Guardian Information
67. First Name*
68. Date of Birth*
    Date of Birth
70. Middle Name
71. Texas Drivers License / Texas ID #*
73. Last Name*
75. Address*
77. City*
78. State*
79. Zip Code*
81. Phone Number*
82. Email Address*
86. Emergency Contact Information
88. First Name*
89. Date of Birth*
    Date of Birth
91. Middle Name
93. Last Name*
95. Address*
97. City*
98. State*
99. Zip Code*
101. Phone Number*
102. Email Address*
Leave This Blank:


104. 1. Receive an email copy of this form.
105. Email address

     This field is not part of the form submission.

106. Submit

* indicates a required field