Citizens Police Academy Application

Application for the Lake City Police Department

Citizens Police Academy

225 NW Main Blvd., Suite 102
Lake City, Florida 32055
(386) 752-4343

AN EQUAL OPPORTUNITY EMPLOYER

In compliance with the ADA, qualified individuals with disabilities who will need reasonable accommodations in order to apply or complete any required test should inform the Human Resources Director at least 48 hours before said accommodations are needed.

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Full Name *

Nickname

Address *

Apt

City *

State *

Zip *

Home Phone

Cell Phone

E-mail Address *

Date of Birth

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Place of Birth

Race

Sex

Height

Hair

Eyes

Driver's License *

Expiration

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DL Type

Valid

Yes

Emergency Contact Full Name *

Emergency Contact Address *

Emergency Contact Apt

Emergency Contact City *

Emergency Contact State *

Emergency Contact Zip *

Emergency Contact Home Phone

Emergency Contact Cell Phone

Emergency Contact Employed At

Emergency Contact Work Phone

Criminal History

Yes

Have you ever been arrested or charged with a crime, whether as an adult or juvenile, even if the record was expunged or sealed?

Please provide details.

Additional Comments

Use this section for additional comments, explanations, additional educational history, etc., wherever such space does not already exist. Please indicate the application section along with each comment below.

Citizens Police Academy Application

Application for the Lake City Police Department

Citizens Police Academy

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