ATF

CITIZENS ACADEMY APPLICATION

The following questions are for initial screening purposes ONLY. All of your responses will be verified, so it is imperative you answer honestly.

PERSONAL BACKGROUND

First Name:

Middle Name:

Last Name:

List all other names (nicknames, maiden name):

Date of Birth:

Place of Birth:

Gender:

Current Address:

Cell Phone:

Work Phone:

Email Address:

EMERGENCY CONTACT

Name:

Relationship:

Phone:

EMPLOYMENT INFORMATION

Current Employer:

Job Title:

Business Address:

ORGANIZATIONAL MEMBERSHIP

List organizations, associations or community groups to which you belong:

How did you learn about ATF Citizens Academy?

Why are you interested in attending the ATF Citizens Academy?

In what way will your attendance at the ATF Citizens Academy benefit your community?

If selected to attend the ATF Citizens Academy, would you be willing to support the ATF Citizens Academy Alumni Association at community events, critical incidents and similar functions?

AUTHORIZATION TO CONDUCT LAW ENFORCEMENT CHECK

Have you been arrested within the last 6 months?

Have you ever been convicted of a felony or serious misdemeanor?

If you answered YES to either question, please provide details including date, place, law enforcement agency, charges, court and disposition:

Printed Full Name: