Citizens Police Academy Application

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Tennessen Warning, Minn.Stat.13.04, Subd. 2
The information requested on this form will be used for consideration of your participation in Moorhead Police Department's Citizens Police Academy (CPA). Its intended use is to assist Police Department personnel to conduct a background check to verify eligibility of participating in the CPA. You are not legally obligated to supply the data. However, failure to do so could result in this department's inability to conduct a background check which is required to verify eligibility to participate in the CPA. Persons authorized to access information include Police Department personnel.
General Information
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First Name:
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Middle Name:
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Last Name:
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Date of Birth:
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Address:
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City:
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State:
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Zip:
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Home Phone:
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Work Phone:
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Cell Phone:
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Email Address:
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Shirt Size:
Drivers License
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Drivers License #:
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State Issued:
Employer Information
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Employer:
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Occupation:
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Employer's Address:
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City:
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State:
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Zip:
Emergency Contact
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Contact Name:
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Address:
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City:
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State
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Telephone Number:
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Relationship
Questions
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Have you ever attended a Citizens Police Academy of any kind in the past?
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If yes, which one?
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Have you been arrested for any offense other then traffic violations?
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If yes,  What for ?
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When?
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Where?
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List/Describe any civic activities or organizations you are involved in:
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What experience have you had with law enforcement?
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Briefly Explain
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How did you hear about our Citizens Police Academy? 
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Why are you interested in the Citizens Police Academy?
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What do you expect to gain from attending this academy?
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I UNDERSTAND THAT SPACE IS LIMITED, ALLOWING ONLY 24 STUDENTS TO PARTICIPATE IN THE CITIZENS POLICE ACADEMY. THEREFORE, I AGREE TO ATTEND AT LEAST 8 OF THE 10 SCHEDULED SESSIONS. ADDITIONALLY, I AGREE TO ARRIVE PROMPTLY AND TO COMPLETE AND RETURN THE EVALUATION FORM PROVIDED FOR EACH SESSION.
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I HEREBY CERTIFY THAT THE INFORMATION CONTAINED IN THIS APPLICATION IS TRUE AND COMPLETE TO THE BEST OF MY KNOWLEDGE. YOU ARE HEREBY AUTHORIZED TO MAKE ANY INVESTIGATION OF MY PERSONAL HISTORY DEEMED NECESSARY FOR CONSIDERATION TO ATTEND THE CITIZENS POLICE ACADEMY.
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