Highland Park Dept. of Public Safety
Registration

APPLICANT INFORMATION
First Name:*

Last Name:*

Position/Title / Rank *

Agency / Organization Name:

Address:*

Address 2:

City:*
State: (ie: TX)* 
  Zip code:*
 

CONTACT INFORMATION
Phone: *

Mobile Phone:

Email:*
 
Password:* (minimum 8 characters, 1 number,
1 special/symbol
)


ADDITIONAL COMMENTS / REFERRED BY