CITIZENS POLICE ACADEMY
Mail this form to:
PEMBROKE PINES POLICE DEPARTMENT
COMMUNITY AFFAIRS UNIT
9500 Pines Boulevard
Pembroke Pines, FL 33025
___________________________________________________
|
|
APPLICATION FORM CITIZENS POLICE ACADEMY
Mail this form to: |
||
| Name: | ___________________________________________________ | ||
| Address: | ___________________________________________________ | ||
| City: | ___________________________________________________ | ||
| State: | ___________________________________________________ | ||
| Zip: | ___________________________________________________ | ||
| Business Name: | ___________________________________________________ | ||
| Business Phone: | ___________________________________________________ | ||
| Home Phone: | ___________________________________________________ | ||
| Social Security # | ___________________________________________________ | ||
| Date of Birth: | ___________________________________________________ | ||
| Driver License # | ___________________________________________________ | ||
| Expiration Date: | ___________________________________________________ | ||
| Issuing State of license: | ___________________________________________________ | ||
| E-mail: | ___________________________________________________ | ||
| Have you ever been arrested? | ( ) No ( ) Yes | ||
| If yes, please explain: | ___________________________________________________ | ||
| ___________________________________________________ | |||
| Explain any medical conditions that will prevent you from participating in certain events: |
___________________________________________________ ___________________________________________________ |