2. Irving Citizens Police Academy Enrollment Application
4. First Name*
5. Last Name*
7. Address*
8. P.O. Box / Apt. Number
10. City*
11. State*
12. Zip*
14. Home Phone Number*
15. Cell Phone Number
17. Email*
18. TX DL#
20. Date of Birth*
    Needed to complete required criminal background check
21. Sex*
    Needed to complete required criminal background check
22. How did you hear about the Academy?
26. Background Information
27. Please explain briefly why you want to attend the Citizens Police Academy.
29. Have you ever been arrested for, convicted of, or cited for an offense other than a traffic violation?

    1. Yes
    2. No
30. Have you been a party of a civil lawsuit in the past 10 years?

    1. Yes
    2. No
32. If yes, explain the details, including charges, places, actions taken, etc.
36. Employment
38. Present Employer
40. Date Hired
42. Occupation and Job Title
44. Address
45. City
47. May we place your name, address and phone number on a class roster?

    1. Yes
    2. No
49. In case of emergency, please call:
53. Certification and Signature*
    I hereby certify that there are no willful misrepresentations, omissions or falsifications in the foregoing statements and answers to questions. I understand that any omission or false statement on this application shall be sufficient cause for rejection of enrollment or dismissal from the Irving Citizens Police Academy. I understand that participation in this program is not to train students to be police officers. Participation is to provide education regarding the purpose, rationale and context of police procedures. I acknowledge that as part of acceptance in the program, I will be required to attend at least 70 percent of the classes. Failure to attend will be cause for dismissal from this program. I will abide by all rules and regulations set forth by the Irving Police Department and the City of Irving and will provide my own transportation and insurance. I further understand that the Irving Police Department will conduct a thorough background investigation that may include criminal history information, employment history and personal references. The Irving Police Department reserves the right to deny any application.
55. Date*
Leave This Blank:


57. 1. Receive an email copy of this form.
58. Email address

    This field is not part of the form submission.

59. Submit

* indicates a required field