Citizens' Police Academy - Application Form

* required field
Name:*
Address Line 1:*
Address Line 2: 
City:*
State:*
Zip:*
Home Phone:*
Employer:*
Work Phone:*
Email:*
Date of Birth:*
Driver's License Number:*
Driver's License State:*
Occupation:*
(if retired, please indicate your former occupation)
I am interested in
attending the class:* 		  January - March
  May - July
  September - November
Comments: 
(max: 500 characters)

Characters left: 500
Special Needs, etc: 
 
Due to the sensitive nature of some of the materials, applicants will be subject to a limited background check to determine their suitability to the course. The check will be limited to criminal history and warrant information. The information will not be used for any other purpose, or shared with any other person or entity. A medical check will not be required or conducted.
 
Have you ever been convicted of a felony?   Yes          No
Have you ever been convicted of any crime involving moral turpitude?   Yes          No
Are you now wanted for any crime/warrant?   Yes          No
Have you ever been a member of any street, prison or motorcycle gang?   Yes          No
Are you currently involved in any civil suit against the City of Palm Springs?   Yes          No
 
A "Yes" answer to any of the above does not necessarily mean disqualification from the program; however, deliberate attempts to falsify information will disqualify the applicant from further consideration.
 
 
Palm Springs Police Department
200 South Civic Drive
Mailing: P.O.Box 1830
Palm Springs, CA 92263
Officer Mike Goodwin, Academy Coordinator - (760) 323-8131 Ext. 8679
Sgt. Mark Stafford, Academy Director - (760) 778-8440 ext. 6315