2. Citizens Police Academy Application

   Fredericksburg 

4. First Name:*
5. Last Name:*
7. Current Address:*
9. City:*
10. State:*
11. Zip Code:*
13. Date of Birth:*
    Date of Birth:
14. Sex:*
    -- Select One --MaleFemale
16. Primary Phone Number:*
17. Secondary Phone Number:
19. Email Address:*
21. Place of Employment:*
23. Employer Address:
25. City:
26. State:
27. Zip Code:
29. Dietary Restrictions/Needs:*
31. How did you hear about the Citizens Police Academy?*
33. Please read below:

    I understand that prior to acceptance, applicants will be investigated for criminal offenses. A prior conviction will not automatically disqualify an applicant and will be considered only as it relates to the Citizens Police Academy. The Fredericksburg Police Department is hereby authorized to investigate my personal history as deemed necessary for consideration to enter the Fredericksburg Citizens Police Academy.

    By typing my name and the date below,  I understand and agree that this form of electronic signature has the same legal force of a manual signature.

35. Signature:*
36. Date:*
    Date:
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38. 1. Receive an email copy of this form.
39. Email address

    This field is not part of the form submission.

40. Submit Submit and Print

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