EmailMe Form - SAN ANGELO PD CITIZEN'S POLICE ACADEMY

PERSONAL

Name

First Middle Last

Date of Birth

Month/Day/Year

Address

Street Address City State / Province / Region Postal / Zip Code

Phone

### - ### - ####

Mandatory Numbers

Driver's License or ID # and State Issued:
Social Security Number:

Image of Driver's License or other photo ID

If you are not able to complete this portion, please bring your Driver's License or other photo ID with you to the first class.

Are you a resident of the City of San Angelo?

For How Long?

Email Address

EDUCATION

High School Graduate?

Yes

No

GED

Highest grade completed:

Name and address of High School:

Street Address City State / Province / Region Postal / Zip Code

College Graduate?

Yes

No

Degree and Major:

Name and address of college(s) attended:

BACKGROUND

Please explain briefly why you wish to be enrolled in the San Angelo Police Department Citizen Police Academy:

Please list any associations, clubs, or organizations you may belong to or be affiliated with:

Have you ever been arrested for, convicted of, or cited for an offense other than traffic fines of $200 or less?

Yes

No

If yes, please explain in detail, listing appropriate dates, charges, places, and action taken:

Have you ever been fired or asked to resign from any job in the last five years?

Yes

No

If yes, please explain in detail:

EMPLOYMENT

List information on the last two jobs you have held (please state if retired, unemployed, homemaker, etc.)

Present Employer:

Employment Address:

Your Job Title:

Date You were hired?

MM / DD / YYYY

Supervisor's Name:

Previous Employer:

Employment Address:

Your Job Title:

Date You were hired?

MM / DD / YYYY

Supervisor's Name:

EMERGENCY CONTACTS

List two immediate family members or close friends who can be contacted in the event of an emergency:

Name/Relationship/Address/Phone
Name/Relationship/Address/Phone

MEDICAL HISTORY

Please list any medications you are currently taking and the condition(s) for which they are prescribed. This information will be referred to ONLY in the event of an emergency

Is there any other medical or health information you feel the San Angelo Police Department should be aware of? If so, please include in the space provided above.

Please review your answers carefully and read the statement below before submitting this application.

I hereby certify that there are no willful misrepresentations, omissions, or falsifications in the foregoing statements and answers to questions. I understand that any omission or false statement on this application shall be sufficient cause for rejection for enrollment to or dismissal from the San Angelo Police Department Citizen Police Academy.

I further understand that the San Angelo Police Department will be conducting a thorough background investigation that may include, but is not limited to, any criminal history, employment history, and personal references.

Completing this Enrollment Application, selecting 'Accept' below, and completing the 'SMART CAPTCHA Anti-SPAM' feature below serves as your temporary personal signature.

Online applicants will be required to sign their Enrollment Application by the first day of the Academy.

Accept

Decline