Please provide the following information:

 

Name:
Gender:
Race:
Social Security Number:
Driver's License Number:
Work Phone:
Home Phone:
E-mail (*required):
Address:
City:
Zip:
Date of Birth:
Occupation:
How long with employer:
Business address:

Have you ever been arrested for any offense?

No Yes

If yes, state when, where and describe the circumstances:

Why do you want to attend the Citizen's Police Academy?

List any civic organization involvements:

By clicking "Submit Form" you authorize the Kenner Police Department to conduct a criminal records check and other investigatory procedures for the purpose of evaluating this application.