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2. Full Legal Name
4. Date of Birth
   Date of Birth
5. Sex
6. Race
8. Current Address
10. City
11. State
12. Zip Code
14. Home Telephone Number
15. Cell Phone Number
17. Email Address
19. Employer
20. Occupation
22. Work Address
24. List any organizations that you are affiliated with.
26. Briefly state why you would like to be in the Citizens Police Academy
28. Electronic Signature
    Your electronic signature on this form indicates you are granting permission for the Frankfort Police Department to conduct a Criminal History check on you, prior participation in the Citizens Police Academy. It is further agreed that should this Criminal History check reveal any convictions of a criminal nature or high traffic offenses, the Frankfort Police Department may, at their discretion, disallow your participation in this program.
30. Agreement*

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
    2. I do not agree.
32. Electronic Signature*
Leave This Blank:


34. 1. Receive an email copy of this form.
35. Email address

    This field is not part of the form submission.

36. Submit

* indicates a required field