Action Center / Application for Citizen Academy / Florissant, Missouri

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Carefully answer each question accurately. An applicant may be disqualified from attending the Citizen Academy if he/she intentionally makes a false statement of material fact or practices or attempts to practice any deception or fraud in this application.

You can either complete this form online, or print off a pdf version and bring it to the Florissant Police Department. The paper form can be found here: Application for Citizen Academy

* Denotes a required field

Full Name Middle initial*

List all other names you have used, including maiden names, nicknames and aliases:*

Address*

City*

State*

ZIP*

Zip-Zip +4
Second portion of ZIP Code is optional.

Occupation*

Employer*

Address*

City*

State*

ZIP*

Zip-Zip +4
Second portion of ZIP Code is optional.

Employer Phone*

Phone Area Code-Phone 3-Phone 4 ext Extension

Home Phone*

Phone Area Code-Phone 3-Phone 4 ext Extension

Date of Birth*

MonthDay Year,

Please Do Not Complete The Following Field

Age*

Sex*

Male Female

Are you a U.S. Citizen*

Do you have a valid Driver License*

Yes No

Driver License Number*

State Issued*

Expiration Date*

MonthDay Year,

Contact Email*

Have you ever been arrested, detained or taken into custody in this state, any other state, in the military, or any other entity for any reason at all?*

Yes No

If yes, please explain: Indicate the date, violation charged, location, court disposition, police agency involved, and report (case) number of incident. A record check will be completed on each applicant.

Application for Citizen Academy

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