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2. 
4. WFPD CITIZEN POLICE ACADEMY ONLINE APPLICATION
   Please fill out form completely before submitting. ALL information is required. If a blank does not apply, type "NONE" or "N/A". Applicants must be 18 years of age or older.
6. Full Name (First Middle Last):*
7. Date of Birth (MM/DD/YYYY):*
9. Street Address:*
10. Contact Phone # (xxx-xxx-xxxx)*
12. City, State, Zip Code:*
13. Email Address:*
15. Drivers License State and Number:*
16. SSN (Last Four Digits ONLY):*
18. Current Employer:*
19. Position:*
21. Work Supervisor:*
22. Work Phone # (xxx-xxx-xxxx)*
24. Personal Reference 1 - Name:*
25. Personal Reference 1 - Phone #:*
27. Personal Reference 2 - Name:*
28. Personal Reference 2 - Phone #:*
30. Have you ever been arrested, convicted, or cited for any crime other than a traffic offense*

    1. YES
    2. NO
32. If YES, please explain and provide dates:
34. How did you hear about this class*
35. If referred, by whom
37. What is your purpose for applying*
39. Which class are you applying for*

    1. Spring ONLY
    2. Fall ONLY
    3. Next Available
41. Each person who has is applying for educational training and/or other community service activities with the Wichita Falls Police Department (WFPD), including but not limited to the Citizen Police Academy, who is to be screened MUST consent to an authorization/waiver/indemnity agreement, giving approval for the City of Wichita Falls/WFPD to perform a background check.
43. I hereby give my permission for the City of Wichita Falls/WFPD to obtain information related to my background and motor vehicle record. The background record, as received from the reporting agencies, may include arrest and conviction data as well as plea bargains and deferred adjudication. I understand that this information will be used in part to determine my eligibility for educational training and/or community service activities with the City of Wichita Falls/WFPD. I also understand that as long as I participate in educational training and/or community service activities with the City of Wichita Falls/WFPD, the background and motor vehicle records check may be repeated at anytime. I understand that I will have an opportunity to review the background and procedure is available for clarification, if I dispute the record received.
45. I do, for myself, my heirs, my executors and administrators, hereby remise, release and forever discharge and agree to indemnify the City of Wichita Falls/WFPD and each of their officers, directors, employees, and agents harmless from and against any and all causes of actions, suits, liabilities, costs, debts and sums of money, claims and demands whatsoever, and any and all related attorney's fees, court costs, and other expenses resulting from the investigation of my background in connection with my applications to participate in educational training and/or community service activities.
47. Do you agree to the above authorization/waiver/indemnity agreement and consent to allowing the WFPD to perform a background check on you as an applicant to the Citizen Police Academy?*

    1. YES
    2. NO
49. For more information, please contact the WFPD Community Services Section at 940-720-5059
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51. 1. Receive an email copy of this form.
52. Email address

    This field is not part of the form submission.

53. Submit

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