Name *

Social Security Number *

Date of Birth *

Address, City, State and Zip *

Home Phone*

Work Phone

Occupation

Email *

Are you at least 18 years of age? *

YES

NO

Have you ever been arrested for a misdemeanor or felony? *

YES

NO

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

YES

NO

POLICE RECORD CHECKS WILL BE COMPLETED ON ALL APPLICANTS

Citizen’s Police Academy applicants will be notified by phone and/or mail to confirm registration.

Contact Captain Fredrick Lemons at 314-505-8661 or email flemons@ucitymo.org for additional information.

All applicants must sign this application to be considered a candidate for the Citizen’s Police Academy. This signature gives your authorization for a police record check.

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. *

I agree, electronic signature

Name*

Today's date *