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Survey/Form Review
Citizen Police Academy Application
Please answer all questions, incomplete applications may not be processed. Please do not leave blank lines on the application, enter N/A or NONE where applicable. Applicants must live or work in the City of Richardson.

Please enter your full legal name as it appears on you Driver's License:
First Name:
Middle Name (If on your Driver's License an Initial only is listed, please write out your full middle name):
Last Name:
Maiden name and/or any other names you have gone by:

Preferred Name or Nickname:

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:

Cell Phone:

Email Address (For you to receive class information):


Work Information
Employer or Company Name:

Work Address:

City:

Zip:

Work Title or Position:

Retired? Yes or No:

What company did you retire from?

What was the last position held?


How many years of education completed?:

Name, City and State of high school you attended:

Name, City and State of the College you attended:


Have you been arrested?*
Short explanation of the arrest(s). This includes deferred adjudication and expunged cases. Juvenile records not required:

Organization(s) you belong to and position(s) held:

Are you an active member in any of the following? (select all that apply)
US Citizen?
What country were you born in? (If not in the United States)

What year did you enter the United States?
Please tell us why you are interested in CPA:

At the conclusion of the course, do you have an interest in either of the following? (Check all that apply):

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.)
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