NORTH LAS VEGAS POLICE DEPARTMENT NEIGHBORHOOD WATCH COORDINATOR/BLOCK CAPTAIN APPLICATION To apply as a Block Captain, fill out this application. Then take the application, a valid state issued driver’s license, identification card, or Military I.D. to the NLV Police Department Fingerprint/Work Permit Bureau, located at 1301 E. Lake Mead Blvd. (on the corner of Lake Mead & Bruce Street). HOURS FOR PROCESSING ARE MONDAY THRU FRIDAY. 8:30 A.M. TO 4:00 P.M. ***Pleas e no te, M ondays & Fridays te nd to be bus ier days at the W ork Card B ureau , so you m ay prefer to go on T uesd ay, We dnes day, or Th ursda y. NAME :____________________________________________________________________________________________ Las t First Middle ADDR ESS: ________________________________________________________________________________________ Street North Las Vegas, NV _____________________________ PHON E #: (702)_____________________________________ Zip Code E-MAIL ADDRESS :_________________________________________________________________________________ SUBDIVISION/NEIGHBO RHO OD N AME: _______________________________________________________________ Birthdate:____________ Hair: ____________ SSN: ______ -_____-_____ Eyes: ______________ Race: ___________ Sex: ______ ______ Height: _____________ W eight: ____________ PLACE O F BIRTH:__________________________________________________________________________________ City State Coun try HAVE YOU EVER BEEN ARRESTED OR CITED FOR ANY OFFENSE (EXCLUDING SPEEDING AND PARKING VIOLA TIO NS)? YES _________ NO _________ IF YES, PLEASE LIST ALL ARRESTS: YEAR OFFENSE ARRESTING AGENCY CITY/STATE DISPOSITION BY SIGNING BELOW, I AUTHORIZE THE NORTH LAS VEGAS POLICE DEPARTMENT TO CONDUCT A CRIMINAL BACKGROUND CHECK & INVESTIGATION: SIGNATU RE: ______________________________________ DATE: __________________________ (Spa nish A pplication Ava ilable U pon Req uest)