Citizen's Police Academy Application

2. 

4. Applicants must be at least 18 years old and be a resident or business owner in the City of Maumelle. Classes will be held at the Maumelle Police Department. Admission is by application only. A background check will be performed on each applicant.

6. First Name*
7. Last Name*
9. Street Address*
10. Apartment/Unit Number
11. City*
13. State*
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14. Zip Code*
15. Cell Phone*
16. Home Phone
18. Occupation
19. Employer
21. Email*
22. Confirm Email*
24. Gender*

    1. Male

    1. Female
25. Date of Birth*
    Date of Birth
27. Why do you desire to attend the Citizen's Police Academy?*
29. Please provide two personal references
31. First & Last Name*
32. Phone (with extension if applicable)*
34. First & Last Name*
35. Phone (with extension if applicable)*
37. I authorize the Maumelle Police Department to conduct a background investigation to obtain any information relating to my criminal history record for the purpose of making a determination of eligibility for the Citizen's Police Academy. *

    1. By checking this box, I agree to the above
Leave This Blank:


39. 1. Receive an email copy of this form.
40. Email address

    This field is not part of the form submission.

41. Submit

* indicates a required field