CPA Application

2. 

4. Applicants MUST be 18 years of age and live or work in the City of Farmers Branch. Incomplete applications will not be considered.

   Applicants MUST be 18 years of age and live or work in the City of Farmers Branch. Incomplete applications will not be considered.

6. PERSONAL

8. Name (Last, First, Middle)*

9. Date of Birth*

11. Street Address*

12. Home phone*

14. City / State / Zip*

15. Drivers License*

16. Business phone*

18. Email*

19. Cell phone*

21. Resident of Farmers Branch?*

    1. Yes
    2. No

22. If yes, how long?

23. Employed in Farmers Branch?*

    1. Yes
    2. No

24. If yes, how long?

26. BACKGROUND

28. Have you ever been arrested for, convicted of, or cited for an offense other than traffic fines?*

    1. Yes

    1. No

30. If yes, please explain in detail, listing appropriate dates, charges, places and action taken.

32. REFERENCES

34. Present employer*

35. Job title*

36. Supervisor*

38. Address*

39. Telephone*

40. Date hired*

42. Personal reference*

43. Address*

44. Phone*

46. Emergency contact name*

47. Phone*

48. Relationship*

50. RECOMMENDATIONS

52. Were you recommended to apply for the Citizen Police Academy?*

    1. Yes

    1. No

53. If so, by whom?

55. SIGNATURE

57. 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 statements on this application shall be sufficient cause for rejection for enrollment or dismissal from the Farmers Branch Police Department Citizen Police Academy. I understand and agree there is no charge for the Academy and if selected for enrollment, pledge the time commitment to attend. I further understand and authorize the Farmers Branch Police Department to conduct a thorough background investigation that may include, but not be limited to, any criminal history and/or personal references.

    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 statements on this application shall be sufficient cause for rejection for enrollment or dismissal from the Farmers Branch Police Department Citizen Police Academy. I understand and agree there is no charge for the Academy and if selected for enrollment, pledge the time commitment to attend. I further understand and authorize the Farmers Branch Police Department to conduct a thorough background investigation that may include, but not be limited to, any criminal history and/or personal references.

59. Applicant signature*

60. Date*

62. This application will be forwarded to Officer Rutherford at rutherfords@farmersbranchtx.gov for processing. You may also print and mail to the attention of CPA Program/Farmers Branch Police Department / 3723 Valley View Lane / Farmers Branch, TX 75244.

    This application will be forwarded to Officer Rutherford at rutherfords@farmersbranchtx.gov for processing. You may also print and mail to the attention of CPA Program/Farmers Branch Police Department / 3723 Valley View Lane / Farmers Branch, TX 75244.

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

    This field is not part of the form submission.

66. Submit

* indicates a required field