Georgetown Citizen Police Academy
Application
Date of Application _____/_____/_____
Name of Applicant _____________________DOB____/____/____ SSN_____-_____-_____
______________________________________________________________________________
Address City/Town State Zip Code
Home: (_____)______-______Cell: (_____)______-______ Work: (_____)______-______
Occupation:________________________________ Employeer:__________________________
Highest Level of Education:_______________________________________________________
Special Training, Degrees, or Areas of Expertise:_____________________________________
_____________________________________________________________________________
1. Can you fill the commitment to attend all classes? Yes / No
If No, please explain:______________________________________________________
________________________________________________________________________
2. Why do you wish to participate in this program?_________________________________
________________________________________________________________________
3. Are there any specific areas of police work you hope to have included in the course?____
________________________________________________________________________
4. If you are not selected or available to attend this session, would you be interested in attending
the next scheduled Citizen Police Academy?
_______________________________________________________________________________
I herby make this application for the Citizen Police Academy sponsored by the Georgetown Police Deparment.
I understand that a standard background check will be made using the information I have provided and that
all informatiuon obtained will be destroyed after the completion of the background check. I also understand
that the Georgetown Police Department reserves the right to refuse admission based on discoveries made
through the background check. All the information provided is accurate and true to the best of my knowledge.
_________________________________________ _____/_____/_____
Signature Date
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