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Citizens Police Academy Application

This form has been modified since it was saved. Please review all fields before submitting.

Steps

1. Step One This section is complete This section is incomplete
2. Step Two This section is complete This section is incomplete
3. Step Three This section is complete This section is incomplete
4. Step Four This section is complete This section is incomplete

Step One

First Name
Last Name
Date of Birth
Date of Birth
Driver's License #
Contact Phone #
Address1
Address2
City
State
Zip
Email Address
Continue

Step Two

Business Name
Business Address
City
State
Zip
Occupation or Job Title
Referred by: (Name, Address, Phone)
May we place your name, address and phone number on a class roster?
1. Yes
1. No
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Step Three

In case of emergency, please call: (Name and phone number)
Reference #1 (Name, Address & Phone number)
Please list 3 references
Reference #2 (Name, Address & Phone number)
Reference #3 (Name, Address & Phone number)
Describe in your own words why you are interested in attanding the Citizens Police Academy:
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Step Four

Have you ever been arrested for any offense other than a traffic offense?
1. Yes
1. No
If yes, state the charge(s), date, location of arrest and disposition:
I hereby authorize the Cleburne Police Department to make an examination of my background and references for the purpose of evaluating my application. I also understand that any arrest or falsification of any information included in this application may be grounds for rejection of my application.
Electronic signature constitutes authorization.
Date of Application
Date of Application

Leave This Blank:

1. Receive an email copy of this form.
Email address

This field is not part of the form submission.
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