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Citizen's Police Academy Application

2. Last Name

3. First Name

4. Middle Initial

6. Address

8. City

9. State

10. Zip Code

12. Work Phone

13. Home Phone

14. Emergency Phone

16. Email

17. Date of Birth
    Date of Birth

18. Physical Condition

    1. Excellent
    2. Good
    3. Poor

20. Occupation

21. Place of Employment

23. Why do you wish to attend the Citizen's Police Academy?

25. Have you ever been arrested? If yes, what crime and when?

27. Give the name, address,a nd phone number of two character references:

29. Reference 1

31. Reference 2

33. Applicants are required to be at least 21 years of age and have no criminal record, (no felony convictions and/or arrests for Domestic Abuse Laws) because of firearms training that will take place during this course.<br><br> Any questions about participating in or general questions about the Citizen’s Police Academy prior to submitting the application, please contact Officer Gene Page at 479-271-6200 or <a class="Hyperlink" target="_self" href="mailto:gene.page@bentonville.arkansas.gov">via email</a>.

    Applicants are required to be at least 21 years of age and have no criminal record, (no felony convictions and/or arrests for Domestic Abuse Laws) because of firearms training that will take place during this course.
    
    Any questions about participating in or general questions about the Citizen’s Police Academy prior to submitting the application, please contact Officer Gene Page at 479-271-6200 or via email.

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

    This field is not part of the form submission.

36. Submit

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