Arlington Heights Police Department

Citizen Police Academy Application

Please complete and submit and/or print and return to:

Arlington Heights Police Department
C/O Citizens Police Academy
200 E. Sigwalt Street
Arlington Heights, IL 60005

Cell Phone

Home Phone

Work Phone

Drivers License Number

State Drivers License was Issued

Is your Drivers License Valid?

Yes

Have you ever been arrested for anything other than a traffic offense?

Yes

If Yes, explain When, Where and Disposition

Occupation

Place of Employment

Emergency Contact's Phone Number

Relationship to Emergency Contact

As a way of promoting the Citizen Police Academy (CPA), photographs and video imagery may be taken during academy sessions which might be used on the Arlington Heights Police Department's website or appear in local newspapers.

I certify that all statements made on this application are true and complete. I certify that I am at least 21 years of age and agree to allow the Arlington Heights Police Department to conduct a background check prior to my participation in the CPA. I agree and understand that any deliberate misstatement or omission of material facts may disqualify me to attend the CPA.

My signature below acknowledges my understanding and agreement with the material provided.

Sign Here

First Name

Last Name

Choose how to sign

Draw Type

I agree to electronically sign and to create a legally binding contract between the other party and myself, or the entity I am authorized to represent.