Webster Police Department Citizen Police Academy Application for Admission

Applicant Information

Last Name:*

First Name:*

Middle Name:

Street Address:*

City:*

State:*

Zip Code:*

Home Phone #*

Work Phone #

Cell Phone #

Pager

Email Address

Drivers License #*

Social Security Number:*

Date of Birth:*

Are you employed by or at a business in the City of Webster?*

Yes

No

If yes, name of the business?

Are you a resident of the City of Webster?*

Yes

No

Have you ever been arrested for, convicted of, or cited for a criminal offense other than a traffic offense?

Yes

No

If yes, please explain in detail, listing appropriate dates, charges, places and action taken.

Note: A felony conviction will disqualify an applicant from attending the Citizen Police Academy.

Please review your answers carefully and read the statement below before signing this application.

"I hereby certify that there are no willful misrepresentations, omissions or falsifications in the foregoing statements and answers to question. I understand that any omissions or false statements on this application shall be sufficient cause for rejection for enrollment or dismissal from the Webster Citizen Police Academy.

I further understand that the Webster Police Department will be conducting a thorough background investigation that may include, but is not limited to, criminal history, employment history and personal references, and I have not been convicted of a felony offense in any jurisdiction, Texas or any other state. I also understand that any student may be removed from the Webster Citizen Police Academy if said student is disruptive or otherwise inhibits the concept of this program."

Signature:*

Date:*

Why do you wish to attend the Webster Citizen Police Academy?