Road to Work: Pre-registration Form

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Thursday, November4, 2021 | 8:30 a.m. - 2 p.m. | Alton Police Department- 1700 E. Broadway, Alton

Email *

Please fill out and submit this form by Friday, October 29 to receive assistance with suspended or revoked driver's licenses. This event will help resolve pending misdemeanor charges and warrants without arrest.

Full Name: *

Address: *

Phone Number: *

E-mail (If applicable):

Driver's License Number:

Reason for Suspension:

Date of Ticket/Arrest/Court Judgement:

Law Agency of Charges/Arrest:

Please List All Charges:

Court Case Number:

State's Attorney or Prosecutor for Case

Preregistered individuals will be given priority the day of the event and should arrive at 8:30 if their last name begins with letters A-M or 10:30 for N-Z.

This release, when presented by a duly authorized representative of the Alton Police Department, will constituent my consent and authority to examine and obtain copies and abstracts of records and to receive statements and information regarding my background.

I authorize the release of information to the Alton Police Department relating to Employment, Educational, Birth Record/Citizenship, Military, Selective Service and Police (Driving and Criminal) Data or Records.

This authorization is given in connection with a background investigation being conducted relative to my application for the Road to Work program.

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