VPD Citizens Police Academy Application – The City of the Village

The Village Police Department Citizens Police Academy

Application for Attendance

First Name *

Middle Name

Last Name *

Street Address *

Apartment, suite, etc

City *

State/Province *

ZIP / Postal Code *

Home/Cell Phone Number *

Email Address *

Date of Birth *

Driver's License Number *

Do you own a business or are you employed in The Village? *

If so, where?

Have you ever been arrested for, convicted of, or cited for an offense other than minor traffic violations (excluding DUI)? *

If yes, explain in detail, showing date, charge and action taken.

Please explain why you wish to attend VPD's Citizens Police Academy *

Are you currently employed? *

Name of Employer

Dates of Employment

Address of Employer

Your Title

Supervisor Name

Supervisor Phone Number

Reference Name *

Relationship *

Reference Address *

Reference Phone Number *

Reference Name *

Relationship *

Reference Address *

Reference Phone Number *

Each CPA participant will be provided with, among other things, a class roster. If you are accepted, may we include your name, address and phone number on the roster? *

E-Signature *

Date of Signature

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