application

Application East Ridge Police Department Citizens’ Police Academy Note: Answering yes to any question below will not automatically disqualify you. The intentional omission or falsification of any answer is cause for disqualification. Name: ________________________________________________________________ Address: ______________________________________________________________ City: _______________ State: ____________ Zip: ____________ Polo Size: S M L XL 2X Have you ever gone by any other name? If yes, give name and explain: ______________________________________________________________________ Home Phone: ______________________Cell Phone: _________________ Date of Birth: ______________________U.S. Citizen? ___________ Driver’s License Number/ID #: ____________________________ E-mail Address: _________________________________________ Race (optional): ___________ Sex (optional): _____________ Employer/Occupation____________________________________________________ Business Address: _______________________________________________________ Are you a member of any civic group or professional organization? _______________ ______________________________________________________________________ ______________________________________________________________________ In case of emergency contact info: __________________________________________ ______________________________________________________________________ Why do wish to attend the Citizens’ Police Academy? __________________________ ______________________________________________________________________ Have you ever been arrested/convicted of a crime? If yes, explain: ________________ ______________________________________________________________________ ______________________________________________________________________ I authorize the East Ridge Police Department to conduct a background check prior to my acceptance into the Citizens’ Academy. Signature of Applicant: ________________________________ Date: _____________