Tell Us about Yourself

 *

Tell Us about Yourself

First Name

Middle Name

Last Name

Date of Birth

Social Security Number

Street address

City

State(Select State) Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

Zip code

Phone numberext.

Email address

Employment Information

Company/Organization:

Company/Organization:

What is the name of the company you are employed with?

Employer Street Address

Employer City

Employer State(Select State) Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

Employer zip code

Work Number:

Work Number: ext.

Title/Position:

Title/Position:

Participation Information

Please indicate one of the following:

Please indicate one of the following:

Making an application for current session.

Interested, but not applying at present. Interested in future sessions.

Have you ever been arrested or convicted for a felony offense, DUI, any offense involving illegal narcotics, or any offense involving moral turpitude?

Have you ever been arrested or convicted for a felony offense, DUI, any offense involving illegal narcotics, or any offense involving moral turpitude?

Yes

No

If 'Yes' please explain the circumstances of the offense:

If 'Yes' please explain the circumstances of the offense:

Do you have any reservations concerning participation in any physically-challenging or stress-related activities as part of this academy? (Examples include simulated building searches, firearms demonstrations):

 *

Do you have any reservations concerning participation in any physically-challenging or stress-related activities as part of this academy? (Examples include simulated building searches, firearms demonstrations):

Please comment regarding your interest to participate in the Citizens' Police Academy.  Why would you like to participate, and what are your expectations for the session?

Please comment regarding your interest to participate in the Citizens' Police Academy. Why would you like to participate, and what are your expectations for the session?

I attest that the above statements made on this application are true and complete.  I authorize the Franklin Police Department to examine this information to evaluate my participation in the Citizens' Police Academy.  I understand that the Franklin Police Department Citizens' Police Academy does not certify or qualify citizens to perform any law enforcement services. My typed name below serves as my signature.

I attest that the above statements made on this application are true and complete. I authorize the Franklin Police Department to examine this information to evaluate my participation in the Citizens' Police Academy. I understand that the Franklin Police Department Citizens' Police Academy does not certify or qualify citizens to perform any law enforcement services. My typed name below serves as my signature.

1. To receive a copy of your submission, please fill out your email address below and submit.
2. Email Address

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