CPA Application

Cleburne Police Department
Citizens 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*

Date

TX DL#*

Cell Phone*

Email*

example@example.com

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Employment

Business Name*

Occupation or Job Title*

Business Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Referred by: (Name, Address, Phone Number)

May we place your name, address and phone number on a class roster?*

YesNo

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

Describe in your own words why you are interested in attending the Citizens Police Academy.*

Criminal History

Have you ever been arrested for any offense other than a traffic offense?*

YesNo

If yes, state the charges(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. I certify that my answers are true and complete to the best of my knowledge.

Signature*

Date Signed*

Date

Cleburne Police Department Citizens Police Academy Application

Applicant Information

Employment

Emergency Contact

References

Criminal History

Cleburne Police Department
Citizens Police Academy Application