Citizen Police Academy Application

Citizen Police Academy Application
All applicants must be at least 21 years of age. A background check will be conducted on each applicant. The City of Westwego Police Department reserves the right to deny entry to the academy based on findings of the background check.
Full Name *

First Name Middle Name Last Name Suffix
Date of Birth *

Month Day Year
MM/DD/YYYY Date Picker Icon

Home Address: *

Street Address
Street Address Line 2 /Apt #
City	State
Zip Code	Country

PRIMARY Phone Number (REQUIRED) *

Area Code Phone Number
Cell Phone Number:

Area Code Phone Number
Work Phone Number:

Area Code Phone Number
E-mail Address: *
Gender: *

Male Female
Drivers License Number: *

Which State was your drivers license Issued: *

Street Address
Street Address Line 2
City	Select State
Zip Code	Country

Drivers License Expiration Date: *

Month Day Year Date Picker Icon
Have you ever been convicted of a felony? *

Employer or Business Name: *

Address

Street Address
Street Address Line 2
City	State
Zip Code	Country

Supervisor Name

Prefix First Name Last Name

Application Verification

All applicants must be at least 21 years of age. A background check will be conducted on each applicant. The City of Westwego Police Department reserves the right to deny entry to the academy based on findings of the background check.

Applying your signature below verifies that the information on the above application is true. I authorize the City of Westwego Police Department to conduct a background check based on this application.
Application Verification Signature *

Clear
Hold Harmless Agreement

I am applying to be a participant in the Westwego Police Department’s Citizen Police Academy. I understand that my
participation will include classroom lectures, field trips, a ride along, etc.

In consideration of my being permitted to attend the Citizen Police Academy, I agree to assume all risks associated with my participation, and release and hold harmless the City of Westwego, The Westwego Police Department, its officers and employees from and against any and all claims, damages, liabilities, costs and expenses, including attorney’s fees, arising out of my participation, including without limitation any personal or bodily injuries or property damage that I may incur as a result of the actions of myself or other persons.

I agree to abide by all rules and instructions given by the officers or employees with respect to my participation.

I warrant that I am of Legal age and fully understand the foregoing terms.
Hold Harmless Agreement Signature *

Clear
Place a check in the box. *
Should be Empty: