Police Academy Application Form

General Information

Name*

First NameMiddle NameLast Name

Social Security Number*

xxx-xx-xxxx

Date of Birth*

Current Mailing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Permanent Mailing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

E-mail Address*

e.g., example@example.com

Preferred Phone Number *

Area CodePhone Number

Place of Birth*

City, State

Race*

Driver's License Information

Height*

e.g., 5'7"

Weight*

e.g., 170 lbs

Eye Color*

Hair Color*

Driver's License Number*

State Issued By*

Date Issued*

Date Expires*

Background and Police Contracts

Read the following questions and answer each truthfully with the understanding that this information is needed to confirm your qualifications for admission. Understand that providing false information will result in dismissal from the Academy.

1. Are you a citizen of the United States?*

YesNo

2. Are you at least 18 years of age?*

YesNo

3. Do you possess a high school diploma or equivalent (GED)?*

YesNo

4. Do you hold a valid driver’s license?*

YesNo

If you answer yes to any questions numbered 5 through 20 below, please provide a full written explanation in question 21. Court disposition papers, when available, should be uploaded to question 22. This includes any juvenile offenses.

5. Have you ever been arrested for, or charged with a felony?*

YesNo

6. Have you ever been convicted of, pled guilty to, or entered a plea of nolo contendere (no contest) to any felony charge?*

YesNo

7. Have you ever been arrested for, or charged with, any crime associated with domestic violence?*

YesNo

8. Have you ever been convicted of, pled guilty to, or entered a plea of nolo contendere (no contest) to any charge of domestic violence?*

YesNo

9. Have you ever been arrested for, or charged with, driving while intoxicated or impaired?*

YesNo

10. Have you ever been convicted of, pled guilty to, or entered a plea of nolo contendere (no contest) to any charge of driving while intoxicated or impaired?*

YesNo

11. Have you ever been arrested for, or charged with, any controlled substance violations?*

YesNo

12. Have you ever been convicted of, pled guilty to, or entered a plea of nolo contendere (no contest) to any charge associated with controlled substances?*

YesNo

13. Have you ever been arrested for, or charged with any crime associated with theft or larceny?*

YesNo

14. Have you ever been convicted of, pled guilty to, or entered a plea of nolo contendere (no contest) to any charge associated with theft or larceny?*

YesNo

15. Have you ever been arrested for, or charged with, any other violation of federal or state law or municipal or county ordinance?*

YesNo

16. Have you ever been convicted of, pled guilty to, or entered a plea of nolo contendere (no contest) to any other violation of federal or state law or municipal or county ordinance?*

YesNo

17. Have you received any traffic citations in the past three years?*

YesNo

18. Have you received any traffic citations in the past three years?*

YesNo

19. Have you ever been pardoned, entered into a pre-prosecution diversion program or received a suspended or deferred sentence, or conditional discharge for any crime (including traffic offenses)?*

YesNo

20. Have you served in the armed forces of the United States?*

YesNo

21. Please explain the reason why you answered "Yes" to questions 5 through 20 above.

22. Additional Information

Browse Files

e.g., If you have court disposition papers, please upload them here. This includes any juvenile offenses.

Letter of Intent

In two paragraphs, describe your career goals and explain why you want to attend the WNMU Police Academy.*

Acknowledgment

I certify the information provided on this application and any attachments is true and correct to the best of my knowledge. I understand that providing false information will be grounds for dismissal from the Academy. I further understand that all release of information, waiver of liability and other application forms, affidavits, agreements or consents required by the Department of Public Safety, Training and Recruiting Division apply completely and equally to the Western New Mexico University Police Academy.

I also understand that my admission to the Western New Mexico University Police Academy is conditional until I have met each and every requirement of the Department of Public Safety, Training and Recruiting Division, as well as those of Western New Mexico University.

Please read the acknowledgment statement carefully and check the I agree box below to continue:*

Signature

WNMU Police Academy Application Form