1 Start 2 Complete First and Last Name: * Address: * City: * Date of Birth: * Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year20222023202420252026 Telephone Number: * E-mail Have you ever been arrested for any offense other than traffic? If yes, please answer the additional three questions below. Yes No For what reason were you arrested? When were you arrested? Where were you arrested? Briefly explain your interest in the Citizens Police Academy Has your experience with law enforcement been good or bad? Good Bad Briefly explain your experience with law enforcement? Signature: * Date: * Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year20222023202420252026
