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2. Event:*
4. Date and Time:*
   Date and Time:

   Date and Time:
5. Location:*
7. Uniform & Equipment and Uniform of the Day with Vehicle*

   1. General - $50.00 per hour (4 hour minimum / $200)
   2. Traffic - $60.00 per hour (4 hour minimum / $240)
   3. House Moving - $100 for the first hour and $60.00 for each additional hour
   4. Other
9. Number of Officers Requested:*
   -- Select One --0123456
10. Total Pay per Officers:*

11. Cancellation Policy - Any cancellation within 24 hours of the EXTRA DUTY JOB will require a payment of half of the agreed total pay.

13. Point of Contact:*
14. Point of Contact Phone #:*

16. For Internal Use Only

    ** Once an Officer has placed his or her name on this document, it will not be removed unless another officer has signed up for the replacement or there is an emergency situation approved by Captain Jeff Brown **

    Deputy: _________  Date: _________  Deputy: _________  Date: _________      

Leave This Blank:


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

    This field is not part of the form submission.

20. Submit Submit and Print

* indicates a required field