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NYPD School Crossing Guard Registration Form

* Fields are required

First Name*

Middle Initial

Last Name*

Date Of Birth*

Do you have authorization for US employment?*

Have you ever used or been known by an alias?*

If Yes, please list names you have used:*


Street Address*

Enter "PH" for Private House or add Apartment Number*

City*

State

Zip Code*

Resident Police Precinct

Borough

Willing to work in another Precinct?*

If Yes, which Precinct*

Do you have a third choice for work in another Precinct?*

If Yes, which Precinct*

Home Phone:

Primary Phone:*

Email Address*

Have you ever served in the Military?*




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