Citizens' Police Academy Application

Indio Police Department

Citizens On Patrol Application

Last Name: First: M.I.: S.S. #:

Address: City: Zip Code: Home Phone:

Date of Birth: Driver's License #: Exp. Date: Work Phone:

In Emergency Notify: Phone #: Relationship:

E-Mail address:

Have you ever been arrested? If Yes, Describe:

List Three (3) References - Please Exclude Relatives:

Name: Address: Occupation: Phone:

Name: Address: Occupation: Phone:

Name: Address: Occupation: Phone:

Describe briefly why you are interested in attending the Citizens' Police Academy and/or taking part in Citizen's on Patrol:

List any Indio police officers you know: For Office Use Only

Note: Class selection is at the discretion of the Chief of Police.

Mail completed application to: Indio Police Department Attention: Volunteer Services Unit / Admin Services Division 46-800 Jackson Street Indio, CA 92201

© 2005 City of Indio

Last Name:	First:	M.I.:	S.S. #:
Address:	City:	Zip Code:	Home Phone:
Date of Birth:	Driver's License #:	Exp. Date:	Work Phone:
In Emergency Notify:		Phone #:	Relationship:
E-Mail address:
Have you ever been arrested? If Yes, Describe:


List Three (3) References - Please Exclude Relatives:
Name:	Address:	Occupation:	Phone:
Name:	Address:	Occupation:	Phone:
Name:	Address:	Occupation:	Phone:
Describe briefly why you are interested in attending the Citizens' Police Academy and/or taking part in Citizen's on Patrol:




List any Indio police officers you know:		For Office Use Only



Note: Class selection is at the discretion of the Chief of Police.