1

Night Club

 *

Night Club

2

Date

 *

Date

3

Number of Bouncers Employed

 *

Number of Bouncers Employed

4

Check which quarter is being reported

 *

Check which quarter is being reported

Jan-Mar due April 15

Apr-Jun due July 15

Jul-Sep due October 15

Oct-Dec due January 15

5

List full legal names of bouncers employed (previous quarter)

List full legal names of bouncers employed (previous quarter)

	Name	Date Employed	Criminal record check within 30 days of employment	Initial training within 90 days of employment	Annual Criminal Record Check & Attach	Biennial training (every 2 years) by Police Dept.
1.	List full legal names of bouncers employed (previous quarter)	List full legal names of bouncers employed (previous quarter)	List full legal names of bouncers employed (previous quarter)	List full legal names of bouncers employed (previous quarter)	List full legal names of bouncers employed (previous quarter)	List full legal names of bouncers employed (previous quarter)
2.	List full legal names of bouncers employed (previous quarter)	List full legal names of bouncers employed (previous quarter)	List full legal names of bouncers employed (previous quarter)	List full legal names of bouncers employed (previous quarter)	List full legal names of bouncers employed (previous quarter)	List full legal names of bouncers employed (previous quarter)
3.	List full legal names of bouncers employed (previous quarter)	List full legal names of bouncers employed (previous quarter)	List full legal names of bouncers employed (previous quarter)	List full legal names of bouncers employed (previous quarter)	List full legal names of bouncers employed (previous quarter)	List full legal names of bouncers employed (previous quarter)
4.	List full legal names of bouncers employed (previous quarter)	List full legal names of bouncers employed (previous quarter)	List full legal names of bouncers employed (previous quarter)	List full legal names of bouncers employed (previous quarter)	List full legal names of bouncers employed (previous quarter)	List full legal names of bouncers employed (previous quarter)
5.	List full legal names of bouncers employed (previous quarter)	List full legal names of bouncers employed (previous quarter)	List full legal names of bouncers employed (previous quarter)	List full legal names of bouncers employed (previous quarter)	List full legal names of bouncers employed (previous quarter)	List full legal names of bouncers employed (previous quarter)
6.	List full legal names of bouncers employed (previous quarter)	List full legal names of bouncers employed (previous quarter)	List full legal names of bouncers employed (previous quarter)	List full legal names of bouncers employed (previous quarter)	List full legal names of bouncers employed (previous quarter)	List full legal names of bouncers employed (previous quarter)
7.	List full legal names of bouncers employed (previous quarter)	List full legal names of bouncers employed (previous quarter)	List full legal names of bouncers employed (previous quarter)	List full legal names of bouncers employed (previous quarter)	List full legal names of bouncers employed (previous quarter)	List full legal names of bouncers employed (previous quarter)
8.	List full legal names of bouncers employed (previous quarter)	List full legal names of bouncers employed (previous quarter)	List full legal names of bouncers employed (previous quarter)	List full legal names of bouncers employed (previous quarter)	List full legal names of bouncers employed (previous quarter)	List full legal names of bouncers employed (previous quarter)
9.	List full legal names of bouncers employed (previous quarter)	List full legal names of bouncers employed (previous quarter)	List full legal names of bouncers employed (previous quarter)	List full legal names of bouncers employed (previous quarter)	List full legal names of bouncers employed (previous quarter)	List full legal names of bouncers employed (previous quarter)
10.	List full legal names of bouncers employed (previous quarter)	List full legal names of bouncers employed (previous quarter)	List full legal names of bouncers employed (previous quarter)	List full legal names of bouncers employed (previous quarter)	List full legal names of bouncers employed (previous quarter)	List full legal names of bouncers employed (previous quarter)

6

Submitted By:

 *

Submitted By:

7

Phone Number

 *

Phone Number ext.

Mail to Greenville Police Dept, False Alarm Coordinator, P O Box 7207, Greenville, NC 27835-7207 or email to Alarms@greenvillenc.gov or fax to (252) 329-4594.

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