2. Agency Name*
3. If Agency is Rowan County Choose Department
   -- Select One --N/ASheriff's OfficeDetention
5. Officer Full Name
7. First Name*
8. Middle Name*
9. Last Name*
11. Employee - Department ID*

    Contact Comm Center if unsure how number is assigned.

12. Officer Radio Call Sign*
13. Employment Type*

    1. Full-Time
    2. Part-Time
15. Officer Address*
17. City*
18. State*
19. Zip Code*
21. If Officer Wishes Call Information Sent Via Text Please Provide

    1. Cell Phone
    2. Alpha Pager
22. Officer Home Phone Number*
23. Text Device Phone Number
25. Cell Phone Company

    (Verizon, Nextel, etc.)

26. Department Chief*
27. Chief Email*
Leave This Blank:


29. 1. Receive an email copy of this form.
30. Email address

    This field is not part of the form submission.

31. Submit

* indicates a required field