Your name:

City/State of residence*:

Preferred email address:

Daytime phone number:

Evening phone number:

Fax number:

Law enforcement agencies where you hope to apply:

Specific questions you might like to ask during the teleconference call:

Please indicate which days of the week and times (all Eastern Standard Time) you would typically be available for a teleconference call:

Monday :

Noon 5PM 6PM 7PM

Tuesday :

Noon 5PM 6PM 7PM

Wednesday :

Noon 5PM 6PM 7PM

Thursday :

Noon 5PM 6PM 7PM