LACY LAKEVIEW POLICE DEPARTMENT
CITIZENS POLICE ACADEMY
APPLICATION FOR ENROLLMENT
Please print or type the following information:
Date:
-
Month
-
Day
Year
Date
Driver's License Number:
Name:
First Name
Last Name
Date of Birth:
-
Month
-
Day
Year
Date
Address:
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Business Address:
Occupation:
Home Phone:
Format: (000) 000-0000.
Work Phone:
Format: (000) 000-0000.
Cell Phone:
Format: (000) 000-0000.
Email Address:
example@example.com
Do you need special accommodations to attend this class?
YES
NO
If yes, what are those accommodations?
Why do you wish to attend the Citizen Police Academy?
Have you ever been arrested or convicted of a crime?
YES
NO
If yes, please explain:
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Next
Give the names and addresses/phone number of two references:
1) Name:
Address:
Phone:
Format: (000) 000-0000.
Email:
example@example.com
2) Name:
Address:
Phone:
Format: (000) 000-0000.
Email:
example@example.com
************************************************FOR DIVISION USE ONLY************************************************
CRIMINAL HISTORY CHECK:
ATTACHED
NONE
OFFICER:
DIVISION:
NAME AND SIGNATURE OF PATROL COMMANDER/SUPERVISOR APPROVING APPLICATION:
X:
DATE:
-
Month
-
Day
Year
Date
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Submit
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