2. Cornelius Police Department Request for Secondary (Off-Duty) Employment

   To inquire about contracting the assistance of a police officer for your event or business, please fill out this form.

4. First Name*
5. Last Name*
7. Contact Number*
8. Email Address*
10. Event Name*
12. Description of the Event*
14. Date of the Event*
    Date of the Event
15. Anticipated Start and End Time*
17. Number of Attendees*
Leave This Blank:


19. 1. Receive an email copy of this form.
20. Email address

    This field is not part of the form submission.

21. Submit

* indicates a required field