Fill out this form if you are interested in being a Reserve Officer.

This file will be sent to Ptl. J. Gadrim and he will be contacting you as soon as possible.

You must be O.P.O.T.A. certified to be a reserve officer with the Logan Police Department.

 

Full Name:
Drivers License Number:
Date of Birth: mm/dd/yy
O.P.O.T.A. Certified? Y/N
If NO when will you be?
Your Address:	Street: City: State: Zip:
Insert todays date: mm/dd/yy
Insert your Email Address:
Insert your Phone Number:
Best time for us to call:
Background Information
Name of your Mother:
Name of your Father:
Their contact number:
Current Employer:
Employer Phone Number:
Employer Contact Name: