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2. 
3. Citizens Academy Application
5. First Name
6. Last Name
8. Address
10. City
11. State
12. Zip Code
14. Date of Birth
15. Driver License number
17. Email Address
19. Cell Number
20. Home/Business Number
22. Employer:
24. Address
26. City
27. State
28. Zip Code
30. Have you received a traffic violation in the past 10 years?
    -- Select One --YESNO
32. Have you been convicted of a crime?
    -- Select One --YESNO
34. Have you been arrested as an adult?
    -- Select One --YESNO
36. Have you been arrested as a juvenile?
    -- Select One --YESNO
38. Please list any/all associations, clubs and organizations that you are/have been associated with.
40. If you answered yes to any of the previous questions please provide details.
42. Please provide a short narrative as to why you would like to attend our program.
44. I hereby certify that there are no willful misrepresentations, omissions, or falsifications in the foregoing statements, and answers. I understand that any false statements or omissions may results in a rejection for enrollment in the program. I further agree that the Garden City Police Department will be conducting a basic background check. This check will include but is not limited to a criminal history check, driver license check and basic background inquiry. I herby authorize the Garden City Police Department to conduct these inquiries. I understand that these inquiries shall remain confidential and the results shall remain the sole property of the Garden City Police Department.
46. Applicant Signature:
48. Applicant Name (printed):
50. Date:
52. Please return form to the Garden City Police Department Community Resource Officer. 6000 Middlebelt Rd. Garden City Mi. 48135
54. 734-793-1728
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55. Print Only

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