| Print
and mail or fax application to: Charleston Police Department, Community
Services Division, P.O. Box 2749, Charleston, WV 25330
Fax: 304-348-6815 |
|
|
|
Date: |
| Name:
First
Middle
Last |
| List
maiden name or former name: |
| Phone:
Home
Work |
| Address:
Street
City
State Zip |
| Employer:
Position: |
| Employer's
Address: |
| Date
of
Birth:
Place of
Birth: |
| Social
Security
#:
WV Operator's # |
| Physical
Condition: ¨Excellent
¨Good
¨Fair
¨Poor |
| Why
do you wish to attend the Citizen Police Academy? |
| |
| |
| How
did you hear about the Citizen Police Academy? |
| |
| Have
you ever been arrested/convicted of a crime or a traffic offense requiring
jail time? |
|
If yes, explain: |
| Please
give the names, addresses and phone numbers of two character references: |
| 1. |
| 2. |
| I
affirm that the information on this application is true and complete to
the best of my knowledge. I understand that deliberate false statements or
the withholding of information may make me ineligible to be considered as
a Citizen Police Academy applicant. I understand the police department
reserves the right to disqualify anyone convicted of a felony or certain
misdemeanors from participation in this academy. I give the Charleston
Police Department permission to conduct any background investigation they
deem necessary on me as part of the processing of this application, and to
use any information obtained in accordance with the policies of the
Charleston Police Department. |
| Applicant's
signature:
Date: |
