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NYPD School Crossing Guard Registration Form
* Fields are required
First Name*
Middle Initial
Last Name*
Date Of Birth*
Do you have authorization for US employment?*
Yes
No
Have you ever used or been known by an alias?*
Yes
No
If Yes, please list names you have used:*
Street Address*
Enter "PH" for Private House or add Apartment Number*
City*
State
Zip Code*
Resident Police Precinct
Borough
Willing to work in another Precinct?*
Yes
No
If Yes, which Precinct*
Select Precinct
1st
5th
6th
7th
9th
10th
13th
14th (Midtown South)
17th
18th (Midtown North)
19th
20th
22nd (Central Park)
23rd
24th
25th
26th
28th
30th
32nd
33rd
34th
40th
41st
42nd
43rd
44th
45th
46th
47th
48th
49th
50th
52nd
60th
61st
62nd
63rd
66th
67th
68th
69th
70th
71st
72nd
73rd
75th
76th
77th
78th
79th
81st
83rd
84th
88th
90th
94th
100th
101st
102nd
103rd
104th
105th
106th
107th
108th
109th
110th
111th
112th
113th
114th
115th
120th
121st
122nd
123rd
Do you have a third choice for work in another Precinct?*
Yes
No
If Yes, which Precinct*
Select Precinct
1st
5th
6th
7th
9th
10th
13th
14th (Midtown South)
17th
18th (Midtown North)
19th
20th
22nd (Central Park)
23rd
24th
25th
26th
28th
30th
32nd
33rd
34th
40th
41st
42nd
43rd
44th
45th
46th
47th
48th
49th
50th
52nd
60th
61st
62nd
63rd
66th
67th
68th
69th
70th
71st
72nd
73rd
75th
76th
77th
78th
79th
81st
83rd
84th
88th
90th
94th
100th
101st
102nd
103rd
104th
105th
106th
107th
108th
109th
110th
111th
112th
113th
114th
115th
120th
121st
122nd
123rd
Home Phone:
Primary Phone:*
Email Address*
Have you ever served in the Military?*
Yes
No
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