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Citizens Police Academy Application
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First Name
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Middle Name
*
Last Name
*
Street Address
*
City
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State
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Zip Code
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Main Phone Number
*
Work Phone Number
Optional Phone Number
E-Mail Address
Driver's License Number:
*
Date of Birth
*
Are you a Neighborhood Watch Block Captain?
Yes
No
Neighborhood Watch Member?
Yes
No
Please explain how you heard of the Citizens' Police Academy and what you expect to learn:
*
If you require any special accommodations for the Academy, please list them below:
By typing my full name below, I authorize and grant my informed consent to permit the Roseville Police Department to conduct a criminal background check to determine whether I would be eligible to attend the Citizens' Police Academy. I further understand that I will not be accepted as a candidate if I have any criminal record excluding minor traffic offenses.
Type Full Name
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Today's Date
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Completed applications will be reviewed and applicants will be notified by letter regarding acceptance into the Academy.
* indicates required fields.
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