Citizen's Police Academy Registration - Marion Police Department

Name

First

Last

Date of Birth

Driver's License #

Address

City

State/Province

Zip/Postal

Address

Phone

Email

City of Marion Resident?

Yes

No

If yes, how many years?

Marion County Resident?

Yes

No

If yes, how many years?

Do you work in Marion County?

Yes

No

If yes, how many years?

Present Employer

Employer City

Have you ever been arrested for, convicted of, or cited for an offense, other than a minor traffic offense?

Yes

No

If yes, please provide a brief explanation, including the charge(s), year(s), and where it occurred.

Please explain briefly why you wish to enroll in the Marion Citizen Police Academy.

By submitting this form, I authorize the Marion Police Department to complete a criminal records check on me for the purpose of enrolling into the Citizen Police Academy. I understand that the class is limited to 20 persons. The return of this application is mandatory for enrollment in this program and should be filled out as completely as possible, but it also does not guarantee admission into the program.

Citizen’s Police Academy Registration