2. Application for the Westfield Police Department Citizen Police Academy

   Please fill out this form as completely as possible.  Requirements to attend this class are: 21 years of age, reside in or be employed in the City of Westfield, no prior felony charges, no misdemeanor charges within two years of application, and any other past civil/criminal history is evaluated on a per case basis.

     All applicants will be subject to a background check.

4. Last Name
5. First Name
6. Middle Initial
8. Other Names Used
10. Date of Birth
12. Home Address
14. Cell Phone
15. Home Phone
16. Work Phone
18. e-mail Address
20. Driver's License State
21. Driver's License Number
22. Expiration Date
24. Have you ever been charged with a crime?

    1. Yes
    2. No
26. If yes, please explain the charge, where and when it occurred, and the court disposition
28. Place of Employment
30. Work Address
32. How did you hear about the Citizen Police Academy?
34. Do you certify that you meet the minimum requirements listed at the top of this application?

    1. Yes
    2. No
36. Date of Application
    Date of Application

    Date of Application

38. By submitting this application online, you certify that all statements made on this application are true and complete. You authorize any individual, company, organization or institution to release any and all information concerning statements made by you on this application, and do hereby release all parties and individuals connected therewith from all liabilities for any damages whatsoever incurred in furnishing such information. You agree and understand that any deliberate misstatement or omission of material facts may disqualify you from attending the Citizen Police Academy. Submitting this application acknowledges your understanding and agreement with material provided.

Leave This Blank:


40. 1. Receive an email copy of this form.
41. Email address

    This field is not part of the form submission.

42. Submit Submit and Print

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