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2. Company/Person Submitting Request
3. Point of Contact Email Address
5. Company's Physical Address
7. City
8. State
9. Zip Code
11. Point of Contact Name
12. Point of Contact Phone Number
13. Point of Contact Fax Number
15. Job Site Address (Must be within Durham City Limits)
17. City
18. States
    -- Select One --ALAKASAZARCACOCTDEDCFLGAGUHIIDILINIAKSKYLAMEMDMHMAMIFMMNMSMOMTNENVNHNJNMNYNCNDMPOHOKORPWPAPRRISCSDTNTXUTVTVAVIWAWVWIWY
19. Zip Code
21. Emergency Contact Phone Number*

    This  number is of the contact to notify of any incidents after hours. 

22. Emergency Contact Email Address
24. Start Date*
    Start Date

    Please submit application a minimum of 24hrs prior to start date.

25. Hours to be worked per shift (Minimum 3hrs)*
26. Days to be worked*
28. Type of Business*

    1. Retail
    2. Church
    3. School
    4. Construction Site
    5. Other
29. If other, please describe.
30. Is a vehicle required?*

    1. Yes, Marked vehicle only
    2. Yes, Marked or Un-marked vehicle
    3. No
32. Type of Duty to be performed*

    1. Uniform Security
    2. Traffic
    3. Other
33. If other, please explain.
34. Briefly Describe Duties*
36. Have you read the Guidelines?*

    1. Yes

    I have read secondary employment information and are aware of the guidelines for requesting off-duty Durham Police Officers.

Leave This Blank:


38. 1. Receive an email copy of this form.
39. Email address

    This field is not part of the form submission.

40. Submit

* indicates a required field