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2. Please fill out the following application.
4. First Name*
5. Last Name*
7. Address*
9. City*
10. States*
    -- Select One --AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFederated States of MicronesiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyoming
11. Zip Code*
13. Home Phone*
15. Applicants are carefully screened, must be free of any felony convictions, convictions of certain misdemeanor crimes, sign confidentiality and waiver agreements and successfully complete a background investigation check.
17. Have you ever been convicted of a felony, misdemeanor, plead no contest, or have been on probation or parole?

    1. Yes
    2. No
19. If yes, list here all convictions after your 18th birthday (including date, code section, and final disposition on your record).
21. By clicking "Yes" you are stating all above information is true and accurate.

    1. Yes
23. Date Submitted
    Date Submitted
25. Your application will be forwarded to the appropriate staff person for review. Thank you for your interest in the Community Police Academy, if you have any questions or require additional information, please contact SSGT Perez at fperez@ci.greenfield.ca.us
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27. 1. Receive an email copy of this form.
28. Email address

    This field is not part of the form submission.

29. Submit

* indicates a required field