Kauai Police Department
Citizens Police Academy Application
Information provided is confidential and for KPD use only
Personal Information
Name
First name
M.I.
Last name
Gender
Female
Male
Date of Birth
as m/d/yyyy or m-d-yyyy
Occupation
Employer
Please check this box if you have applied for employment at any law enforcement organization(s) in the past or present
Contact Information
Mailing Address
Street address
City
Zip code
Home Phone
Business Phone
ex. ###-####
or ###-####x##
Mobile Phone
Email
Education
How many years of formal education have you completed?
High School - Last Grade Completed
College - Years Completed
Degree/Major
Criminal History
Have you been arrested or convicted of a crime in the last six years?
No
Yes
Reason for Applying
Why do you wish to attend the Citizens Academy?
References
List two persons, not related to you, as references.
Name
Name
Address
Address
Phone
Phone
I give the Kauai Police Department permission to verify information provided.