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Step One

THIS APPLICATION IS FOR WAITE PARK RESIDENTS ONLY.
APPLICANTS RESIDING OUTSIDE OF WAITE PARK MUST SUBMIT THE APPLICATION TO THEIR LOCAL LAW ENFORCEMENT AGENCY.
Last Name*
First Name*
Middle Initial
Date of Birth*
Shirt Size*
Are you willing to share your contact info with the class? *
Address*
City*
State*
Zip Code*
Email address
Phone Number*
Driver's License #
This is used to complete a background check.
Social Security Number
This is not required, but may be requested at a later time to complete a background check.
EMPLOYMENT INFORMATION
Employer*
Employer Address
Job Title
Job Duties
EDUCATION
High School *
Dates Attended
College
Dates Attended
Other
Dates Attended
REFERENCES
List two persons, not related to you, as references
Name*
Name*
Address*
Address*
Phone Number*
Phone Number*
EMERGENCY CONTACT*
Relation to you*
Phone Number*
POLICE CONTACTS*
List ALL previous traffic violations, citations, and police contacts within the last 5 years.
CITIZENS POLICE ACADEMY INTEREST*
Why do you wish to attend and be considered for the Citizens Police Academy?
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CITIZENS POLICE ACADEMY RELEASE OF INFORMATION

IMPORTANT NOTICE TO ALL APPLICANTS
Minnesota law requires that you be informed of the purposes and intended uses of the information you provide to the Metro Citizens Police Academy (MCPA) during the application process.

Any information about yourself that you provide to the MCPA during the application process will be used to identify you as an applicant and to assess your qualifications for the volunteer Citizens Police Academy. Although you are not legally required to supply information, we ask that you supply the information requested in order to be considered for the Citizens Police Academy. If you do not supply the information, it may mean you will not be considered for enrollment in the Citizens Police Academy.
The information will be provided to:
1. Persons authorized to have access to the information under state or federal law; and
2. Persons authorized by court order to have access to the information; and
3. Persons to whom you consent in writing to have access to the information.

All law enforcement personnel in the cities of St. Cloud, Sartell, Sauk Rapids, St. Joseph and Waite Park who need to know the information will have access. I authorize consent to the city representatives making inquiries about me if I am considered for the volunteer Citizens Police Academy. I understand this authorization may be revoked in writing by me at any time and in no event will it be valid for more than one year from the date below.

My signature confirms that I have read and understand the authorization and notice to applicants set forth above. I recognize that my failure to sign accurately, completely or falsify information in this application will automatically disqualify me from consideration in the volunteer Citizens Police Academy.
Electronic Signature Agreement
By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.
1. I agree.
Electronic Signature
Date Signed*
Date Signed

Leave This Blank:

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

This field is not part of the form submission.
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Citizens Police Academy Application

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CITIZENS POLICE ACADEMY RELEASE OF INFORMATION

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