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Cornelius Police Part-Time Telecommunicator Interest Card

First Name*
Last Name*
Address1*
Address2
City*
State*
Zip*
Date of Birth*
Date of Birth
Email*
Day Phone*
Evening Phone*
Preferred Method of Contact*
Have you ever used any illegal drugs? If yes, please explain.*
1. Yes
2. No
Explain:
Do you have any emergency dispatch experience?*
How did you hear about us?*

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Email address

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