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EL PASO POLICE AND TEXAS DEPARTMENT OF PUBLIC (City of El Paso)

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BROWSE CITY OF EL PASO (TX) FORMS

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EL PASO POLICE AND TEXAS DEPARTMENT OF PUBLIC SAFETY
JOINT CITIZEN POLICE ACADEMY
APPLICATION FOR ENROLLMENT
APPLICANT MUST BE 18 YEARS OF AGE TO APPLY (NO HIGH SCHOOL STUDENTS).
PLEASE BE SURE TO COMPLETE THE ENTIRE APPLICATION AND RETURN TO:
Via email: 2828@elpasotexas.gov or marc.couch@dps.texas.gov or in person to:
El Paso Police Headquarters (911. N Raynor) or
Texas Department of Public Safety (11612 Scott Simpson).
Start Date: February 4, 2020
PLEASE PRINT CLEARLY.
PERSONAL:
NAME: ____________________________________________ DATE OF BIRTH: _________________
Last, First, MI mm/dd/yy
ADDRESS: ___________________________________________________________________________
Street # Street name Apt Zip
PHONE: (____)______________/(____)_____________/(____)_______________/(____)________________
Night Time Day Time Cell Other
TX DRIVERS LICENSE #: _____________________ TX ID CARD #: __________________________
E-MAIL ADDRESS (For contact/information only): ___________________________________________
EMPLOYER:_________________________________ OCCUPATION:_______________________
BUSINESS ADDRESS:__________________________________________________________
BUSINESS PHONE:(____)________________________________________________________
Disqualifiers:
1. Conviction of any offense of a Class A Misdemeanor or higher.
2. Currently the subject of, or included “party” of a criminal investigation that has not been adjudicated.
3. Currently having an outstanding warrant for arrest.
4. Any convictions of any offense involving Family Violence.
The listed disqualifiers will result in immediate removal of consideration for attending this event.
I understand that my signature authorizes the El Paso Police Department/Texas DPS to verify all information
contained in this application. I authorize the El Paso Police Department/Texas DPS to conduct a criminal
history check on myself as a requirement to attend the Joint Citizen Police Academy. I further acknowledge
and consent to images (photographs) taken during this program and understand that these images may be
used in future advertisements, promotional materials, or online forums. This consent may be removed by
written request to the El Paso Police Department and Texas DPS.
______________________________________________ ___________________________
APPLICANTS SIGNATURE DATE
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EMERGENCY CONTACTS:
List two immediate family members or friends that we can contact in the event of an emergency.
NAME: ________________________________________ RELATIONSHIP _______________________
ADDRESS: _____________________________________ PHONE #S: ___________________________
NAME: ________________________________________ RELATIONSHIP _______________________
ADDRESS: _____________________________________ PHONE #S: ___________________________
SPECIAL ACCOMMODATIONS:
Please let us know of any special accommodations required due to any disability or illness.
ADDITIONAL INFORMATION:
Please let us know how you heard about our program:
Tell us why you would like to join the Citizen Police Academy?
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EL PASO POLICE AND TEXAS DEPARTMENT OF PUBLIC (City of El Paso)

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Completed 13 February 2021

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