Citizen's Police Academy Application

Your application must be completed fully and submitted to the Police Department. You will be notified if you are selected to participate. The classes are limited to 25 positions and will be afforded in the order we receive completed applications from qualified candidates.

Full Legal Name (Last, First, Middle):

Current Address:

City:

State:

ZIP Code:

(zip example: 12345 or 12345-1234)

Phone:

Alternate Phone:

(ex: (999) 999-9999, or 999 999-9999 x9 (1 to 5 digit extension))

Email:

(ex: joe@mail.com | joe@domain.info | joe.cool@mail.com | joe-c@mail.com)

Current Employer:

Occupation:

Business Address:

City:

State:

ZIP Code:

(zip example: 12345 or 12345-1234)

Why do you want to attend the Citizens' Academy?

Would you like a copy of this form emailed to you?

Have you ever been arrested/convicted of a crime?

If so, please explain:

A criminal history check will be conducted for each applicant before they can be accepted into the academy.
Applicants cannot have had any felony convictions, DWIs, nor Drug convictions in the last five years.

By checking this box, you authorize the Independence Police Department to conduct a criminal history check. * Required

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Citizen's Police Academy Application

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