Section 1 of 1 in this document
Citizen Police Academy Application
Name
First Name
*
Initial
Last Name
*
Maiden Name (if applicable)
Address
Street Address
*
City
*
State
*
Zip
*
Phone Number
*
Email
*
Driver's License
*
Birth Date
Month
*
MM
January
February
March
April
May
June
July
August
September
October
November
December
Day
*
DD
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Year
*
YYYY
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
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1969
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1963
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1956
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1954
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1950
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1946
1945
1944
1943
1942
1941
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1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
Social Security Number (necessary for background check)
*
Organizations you belong to (civic groups, Neighborhood Watch, etc.)
*
Why do you want to attend the Citizen Academy and/or what do you hope to learn?
*
Eligibility
Potential candidates for the Citizen Academy must meet the following criteria:
18 years of age
Must be a resident of the area
No prior felony arrests
No misdemeanor arrests within one year of application
I give my permission to the Pocatello Police Department to conduct a background check to determine if I have a criminal record. The Police Department reserves the right to deny entry to the Academy based on the findings of a background check.
Signature
Signature
First Name
Last Name
Email
Choose how to sign
Draw
Type
I agree to electronically sign and to create a legally binding contract between the other party and myself, or the entity I am authorized to represent.
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