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Last Name
First Name
MI
Preferred Name(for name tag/tent)
Officer/Deputy Corporal Detective Sergeant Lieutenant Captain Major Deputy Chief/Chief Deputy Assistant Chief Chief Sheriff Tele-Communicator Telecommunications Manager Retired Other Rank if other:
Title
PID#
Date Of Birth
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Participant Email
Gender: Female Male
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Education: Less than AA or 60 hours AA or over 60 hours Bachelor's degree Master's degree Terminal degree
Ethnicity: Black Indian Hispanic Asian White / Anglo
Agency / Department
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Admin Email
Mailing Address
City
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Zip
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Precinct
#FT Officers in Department