Purdue Student Security Patrol Pre-Application Please fill in the following form and forward the information to the Purdue Police Department. A member of the police department will telephone you to arrange an interview. Pre-Application Form Name: Student ID: Local Mailing Address: City: State: ZIP: Phone: e-mail: If you're human leave this blank: Home Mailing Address: City: State: ZIP: Phone: Work Study? Yes No If yes, earnings limit: Criminal Convictions? Yes No If yes, please explain: Past Employers Name: Dates employed: Job Description: Reason for Leaving: Name: Dates employed: Job Description: Reason for Leaving: Hometown Police Department: Reason for applying to Student Security Patrol:
