Tecumseh Community Policing Committee Application

Required fields are marked with asterisks (*)

Tecumseh Community Policing Committee Application Form

c/o Tecumseh OPP 963 Lesperance Rd. Tecumseh, ON N8N 1W9

Name

Home Phone Number

Address

City

Postal code

VOLUNTEER WORK

Previous Volunteer Work

Indicate your goals and reasons for volunteering

Indicate any special skills and interests for volunteer work

Languages Spoken:

REFERENCES

Reference 1 Name

Reference 1 Phone No.

Relationship to you

Reference 1 Address, City, Postal Code

Reference 2 Name

Reference 2 Phone Number

Relationship to you

Reference 2 Address, City, Postal Code

Signature (by signing you agree to a police screening)

Clear

Date

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Town of Tecumseh

917 Lesperance Road
Tecumseh ON N8N 1W9

Phone: 519 735 2184
Fax: 519 735 6712

Office Hours:
Offices are open from Monday to Friday
8:30 am - 4:30 pm

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