PFLUGERVILLE POLICE DEPARTMENT CITIZENS POLICE ACADEMY

Application for Student Enrollment

 

All student applications must be completed and returned to the Pflugerville Police Department in order to be considered.  There are only 25 openings in each academy class, therefore, not every application will be accepted.  An eligibility list will be established for last minute cancellations and openings in future academy classes.

NAME(LAST, FIRST, MIDDLE

 

DATE OF BIRTH

DATE OF APPLICATION

MAILING ADDRESS

ZIP CODE

 

HOME PHONE

HOME ADDRESS

 

ZIP CODE

COUNTY OF RESIDENCE

PLACE OF EMPLOYMENT/NAME OF COMPANY

 

OCCUPATION

WORK PHONE

MEMBERSHIP IN COMMUNITY GROUPS, CIVIC ORGANIZATION, ETC.

 

EMAIL

HOW DID YOU HEAR ABOUT THE CITIZENS POLICE ACADEMY

 

 

WHAT IS YOUR OBJECTIVE IN ENROLLING IN THE CITIZENS POLICE ACADEMY, AND WHY SHOULD YOU BE CONSIDERED FOR THE ACADEMY?

 

 

 

 

If you are accepted as a student, you will receive instruction and educational materials related to the law enforcement mission of the Pflugerville Police Department.  As such, some of the material presented will be privileged, or confidential, in nature.  Due to sensitivity of this information, it is necessary for the Pflugerville Police Department to conduct background checks to determine the suitability of those persons desiring to attend academy classes.  Please answer the following questions accurately and completely as possible.  Any intentional misrepresentation or omission of facts will be grounds for denial of admission to the academy, or if already enrolled immediate termination from the program.

A criminal history check will be made on all persons enrolling in the Pflugerville Police Department Citizens Police Academy.

DRIVERS LICENSE, STATE AND NUMBER

 

SOCIAL SECURITY NUMBER

DO YOU GO BY ANY OTHER NAMES OR ALIASES NOW OR HAVE YOU IN THE PAST? Do no include maiden name unless used in the past 5 years.

YES          NO

ARE YOU A MEMBER OF, OR HAVE YOU EVER BEEN AFFILIATED WITH A LAW ENFORCEMENT AGENCY?  IF YES EXPLAIN.

YES          NO

HAVE YOU LIVED OUTSIDE THE UNITED STATES (OR ITS TERRITORIES) IN EXCESS OF 90 DAYS?  IF YES EXPLAIN: (DO NOT INCLUDE MILITARY)

YES          NO

HAVE YOU EVER BEEN CONVICTED OF A FELONY, CRIME INVOLVING MORAL TURPITUDE OR ARE YOU CURRENTLY ON PROBATION/PAROLE FOR ANY OFFENSE?  IF YES EXPLAIN:

YES          NO

NAME AND TELEPHONE NUMBER OF PERSON TO CONTACT IN AN EMERGENCY

RELATIONSHIP

 

 

APPLICANT MUST COMPLETE THE FOLLOWING:

 

I,                                                                                                                              hereby acknowledge that I have completed the above application completely and accurately to the best of my knowledge.  I also acknowledge that the Pflugerville Police Department will be conducting a background investigation on me to determine my suitability for admission to this program.  Permission is hereby granted to conduct a background investigation based on the information given in this application.

 

 

                                                                                                                                                                                                                                               

Signature of Applicant                                                                                                                             Date

 

Mail your complete application to:          PFLUGERVILLE POLICE DEPARTMENT

                                                                CITIZENS POLICE ACADEMY

                                                                P.O. BOX 679

                                                                PFLUGERVILLE, TX. 78691-0679

 

Or bring it in person to:                           1611 E. Pfennig Lane