If you are a Certified Texas Police Officer and would like to register for off-duty contract employment with Point Blank Safety, please complete the form below. NAME & DEPT. INFO First Name Last Name Department ---Fort WorthDallas________AddisonAllenAzleBalch SpringsBedfordBenbrookBurlesonCedar HillCleburneColleyvilleCoppellCorinthCrowleyDeSotoDuncanvilleEnnisEulessFarmers BranchFlower MoundForest HillForneyGlenn HeightsGrapevineGreenvilleHaltom CityHighland VillageHurstKellerLancasterLewisvilleLittle ElmMansfieldMidlothianMineral Wells (partial)MurphyNorth Richland HillsProsperRiver OaksRockwallRowlettSaginawSachseSeagovilleSouthlakeTerrellThe ColonyUniversity ParkWataugaWaxahachieWeatherfordWhite SettlementWylie__________OTHER If "Other" Department Rank ---Chief of PolicePolice CommissionerSuperintendentSheriffDeputy Chief of PoliceDeputy CommissionerDeputy SuperintendentUndersheriffInspectorCommanderColonelMajorDeputy InspectorCaptainLieutenantSergeantDetectiveInspectorInvestigatorOfficerDeputy SheriffCorporalPatrolTrooper __________________________________ WORK CONTACT INFO Street Address (Work) City State Zip Code Work Phone __________________________________ PERSONAL INFO Street Address (Home) City State Zip Code Home Phone Email Address Mobile Phone __________________________________ AVAILABILITY Times and Days available for off duty work Area(s) available for work Do you have a dedicated off-duty marked unit? ---No - The company can provide at a per diem costYes - A. Description of vehicle (Magnetic emblems or permanent)Yes - B. Minimum 500k comprehensive insurance requirementsYes - C. Letter from your department head authorizing its use for off-duty useYes - D. Copies of Insurance, Registration and Inspection certificates.