Franklin Police :: Citizens' Police Academy Admission Application

Please fill out the following form if you want to make application for upcoming sessions of the Franklin Police Department's Citizens' Police Academy. The Social Security number is used solely for verifying employment data. The information sent from this page is secured using Thawte® SSL for data encryption.

PERSONAL INFORMATION
First Name:
Middle Name:
Last Name:
Date of Birth:
Social Security Number:
Address:
City:
State:
Zip Code:
Home Phone Number:
Drivers License Number:
Drivers License State:
Drivers License Expiration Date:
EMPLOYMENT INFORMATION
Company/Organization:
Address:
City:
State:
Zip Code :
Work Phone Number :
Email Address:
Title or Position :
PARTICIPATION INFORMATION
Please indicate one of the following:	Making application for current session. Interested, but not applying at present. Interested in future sessions. No interest.
Have you ever been arrested or convicted for a felony offense, DUI, any offense involving illegal narcotics, or any offense involving moral turpitude?:	Yes No
If 'Yes' please explain the circumstances of the offense:
Do you have any reservations concerning participation in any physically-challenging or stress-related activities as part of this academy? (Examples include simulated building searches, firearms demonstrations:
Please comment regarding your interest to participate in the Citizens' Police Academy. Why would you like to participate, and what are your expectations for the session?
I ATTEST THAT THE ABOVE STATEMENTS MADE ON THIS APPLICATION ARE TRUE AND COMPLETE. I AUTHORIZE THE FRANKLIN POLICE DEPARTMENT TO EXAMINE THIS INFORMATION TO EVALUATE MY PARTICIPATION IN THE CITIZENS' POLICE ACADEMY. i UNDERSTAND THAT THE FRANKLIN POLICE DEPARTMENT CITIZENS' POLICE ACADEMY DOES NOT CERTIFY OR QUALIFY CITIZENS TO PERFORM ANY LAW ENFORCEMENT SERVICES. Electronic Signature:	(type name)

www.franklin-gov.com/police

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