2. Last Name
3. First Name
4. Middle Name
6. Street Address
8. City
9. State
11. Date of Birth
12. Social Security Number
14. Driver's License Number*
15. Issuing State*
17. Home Telephone Number
18. Cell Phone Number
20. Email Address
22. Occupation
23. Employer
25. Work Telephone Number
26. Length of Employment (Years and Months)
28. Personal Reference Name
29. Personal Reference Telephone Number
31. Personal Reference Address
33. Have you ever been arrested?

    1. Yes

    1. No
35. What were you arrested for?
37. Have you ever been convicted of a criminal offense?

    1. Yes

    1. No
39. What was the criminal offense?
41. What is your reason for wanting to participate in the Citizens Police Academy?
43. Participant Release Statement

    Please certify that you are a voluntary participant in the Citizens Police Academy service program. Further certify that you, your heirs, executors, and administrators, forever remise, release and discharge the City of Joplin, including all representatives, and from all manner of actions, causes of action, suits, debts, and sums of money, dues, claims, and demands, in law or equity, by reason of your participation in the Citizens Police Academy.

    1. I agree
45. Statement of Authenticity

    All applicants must be at least 21 years of age. 

    Do you certify that all information in the above application is true?

    1. Yes

    1. No
47. Background Check

    A background check will be done on each applicant. The Joplin Police Department reserves the right to deny entry to the Academy based on the findings of a background check. 

    Do you authorize the Joplin Police Department to conduct a background check based on this application?

    1. Yes

    1. No
Leave This Blank:


49. Submit

* indicates a required field