MPA and CAPA Application

Cleburne Police Department
Minister's Police Academy Application
Please fill out completely. Incomplete applications will not be processed. Please use "N/A" for section(s) that do not apply. The Cleburne Police Department appreciates your interest in service and commends your volunteer spirit.
Applicant Information
Name*

First NameLast Name
Date of Birth*

MonthDayYear
Date
Age*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Cell Phone*
Business Phone
Email*
example@example.com
Social Security No.*
Criminal History and Driving Record
TX DL#*
Has your license ever been suspended/revoked?*

YesNo
If yes, explain.
Have you ever been arrested?*

YesNo
If yes, explain.
Have you ever been convicted of a crime?*

YesNo
If yes, explain.
List the number of traffic citations and accidents you had in the past 2 years:*
List your previous addresses for the previous 5 years:*
Education
High School
Did you graduate?*

YesNo
If yes, date graduated:

MonthDayYear
Date
College
Did you graduate?

YesNo
If yes, date graduated:

MonthDayYear
Date
Major/Minor Degree
College
Did you graduate?

YesNo
If yes, date graduated:

MonthDayYear
Date
Major/Minor/Graduate Degree
Military Service
Branch
Time Served
Date Discharged

MonthDayYear
Date
Rank at Discharge
Type of Discharge
If other than honorable, explain
Emergency Contact
In case of an emergency, who would you like us to contact?*

First NameLast Name
Emergency contact's phone number:*
References
List 3 individuals you have known for at least 5 years. Do not use family members as references. (Please list their name, complete contact phone number and address.)
Reference #1 Full Name*

First NameLast Name
Phone Number*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Reference #2 Full Name*

First NameLast Name
Phone Number*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Reference #3 Full Name*

First NameLast Name
Phone Number*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Employment
Current Employer*
Occupation*
Worked from (Start)

MonthDayYear
Date
Worked to (End)

MonthDayYear
Date
Address (including city, state and zip)*
Employer's Phone Number*
Other Information
Have you ever applied to the Cleburne Police Department or the Police Academy?*

YesNo
If yes, how many times have you applied and when?
If rejected, please explain.
Have you ever volunteered before?*

YesNo
If yes, where and what did you do?
Please briefly state why you wish to volunteer your time with the Cleburne Police Department. (Use another sheet if necessary.) This question must be answered.*
For Clergy and Police Alliance Members Only
Name of Congregation Leader
Name of Congregation
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Office Phone
Email Address
example@example.com
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 groundsfor rejection of my application. I certify that my answers are true and complete to the best of my knowledge.
Signature*

Clear
Date Signed*

MonthDayYear
Date
Should be Empty:

Cleburne Police Department Minister's Police Academy Application

Applicant Information

Criminal History and Driving Record

Education

Military Service

Emergency Contact

References

Employment

Other Information

For Clergy and Police Alliance Members Only

Cleburne Police Department
Minister's Police Academy Application