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2. APPLICATION FOR COMMUNITY POLICE ACADEMY
4. APPLICANT MOTIVATION
6. Why do you want to participate in the Community Police Academy?*
8. What do you believe you can contribute to the Community Police Academy?*
10. PERSONAL INFORMATION
12. Name*
13. Email Address*
15. Address*
17. City*
18. State*
19. Zip Code*
21. Phone Number*
22. Secondary Line
24. Social Security Number
25. Date of Birth*
27. Any other names (maiden name), pseudonyms, or nicknames used:
29. APPLICANT EDUCATION
31. Name of High School or Issuer of GED:*
33. Address*
35. City*
36. State*
37. Zip Code
39. Name of college and location*
41. Major
42. Minor
44. Date Started*
45. Date Finished*
46. Degree Received
48. APPLICANT EMPLOYMENT
50. Name and Address of Current Employer*
52. Description of work performed*
54. MILITARY RECORD
56. Have you served on active duty in the Armed Forces of the United States?*

    1. YES
    2. NO
58. Branch
59. Type of Discharge
60. Basis
62. Date Started
63. Date Ended
64. Are you a member of the Reserves?
66. COURT RECORD
68. Have you ever been convicted of any violation including traffic, but excluding parking tickets?*

    1. YES
    2. NO
70. If yes, please list and describe the incident(s) below*

    Please include all incident(s), including date(s), location(s), department(s) that handled the incident(s), along with any charges or relevant details.

72. MEMBERSHIP ORGANIZATIONS
74. Are you or have you ever been a member of any club, society or organization?*

    1. YES
    2. NO
76. If yes, please explain affiliation below. If no, reply N/A.*

    Please include the name and location of each organization, along with the dates of your affiliation, the extent of your activity, and any titles or positions held.

78. RELATIVES
80. Do you have any relatives employed by the Town of Easton?*

    1. YES
    2. NO
82. If yes, please list their names and your relationship to them below. If no, reply N/A.*
84. DRIVERS LICENSE
86. Do you have a valid driver's license?*

    1. YES
    2. NO
88. License Number
89. State
91. PERSONAL DECLARATIONS

    I CERTIFY THAT EVERY ANSWER AND STATEMENT THAT I HAVE MADE IN THIS APPLICATION FOR ENROLLMENT IS TRUE AND COMPLETE TO THE BEST OF MY KNOWELDGE. I UNDERSTAND THAT ANY FALSE OR INCOMPLETE ANSWER MAY BE GROUNDS FOR REJECTION. I AUTHORIZE INVESTIGATION OF ALL STATEMENTS CONTAINED IN THIS APPLICATION FOR ENROLLMENT, TO INCLUDE A CRIMINAL HISTORY CHECK, FOR THE PURPOSE OF EVALUATING MY APPLICATION.

93. 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.
95. Electronic Signature*
96. DATE*
98. Disclaimer

    The Town of Easton considers applicants for the Community Police Academy without regard to race, color, religion, sex, national origin, marital or veteran status, the presence of a non-job-related medical condition or disability, or any other legally protected status.

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

     This field is not part of the form submission.

102. Submit

* indicates a required field