City of Richardson, TX : A Form

Survey/Form Review

Citizen Police Academy Application

Please answer all questions, incomplete applications may not be processed.

Please enter your full legal name as it appears on you Driver's License:

Maiden name and/or any other names you have gone by:

Preferred Name or Nickname:

Race:

Sex:

Date of Birth (Please enter in this format, MM/DD/YYYY):

Texas Driver's License Number:

Home Address:

City:

Zip:

Home Phone:

Work Phone:

Email Address (For you to receive class information):

Work Information

Employer or Company Name:

Work Address, Street Info:

Work Address, City:

Work Title or Position:

Retired? Yes or No:

High School Grad? Yes or No:

GED? Yes or No:

How many years of education completed?:

Name of high school you attended:

Name of College you attended:

Have you been arrested?

Yes

Short explanation of arrest:

Organizations you belong to:

Brief comments about why you are interested in CPA:

BY SUBMITTING THIS APPLICATION, YOU CERTIFY THAT YOU UNDERSTAND AND GIVE YOUR FULL CONSENT TO THE RICHARDSON POLICE DEPARTMENT TO CONDUCT A CRIMINAL HISTORY CHECK. (THIS INFORMATION WILL BE KEPT CONFIDENTIAL AND IS NOT RELEASABLE TO THE PUBLIC.)

To prevent spam we utilize a verification code system. Please enter the code as it is shown in the box above:

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