Kemah Police Department
1401 State Highway 146 • Kemah, TX 77565
Telephone: (281) 334-5414 • Fax: (281) 334-4873
Chief of Police – Walter Gant
Date: __________
TO BEGIN THE APPLICATION PROCESS, CHECK THE APPROPRIATE RESPONSE OR FILL IN THE
BLANK. THIS IS NOT AN APPLICATION FOR EMPLOYMENT.
POSITION SOUGHT:
_____ OFFICER _____ RESERVE OFFICER _____ TELECOMMUNICATOR
Name: ______________________________________________________ Date of Birth: _______________
Address: ______________________________City:_____________________State/Zip:_________________
Place of Birth: __________________________ Social Security # _________-_____-_________
Driver’s License # _____________________ Home Phone # (______)_______-_________
Cell Phone # (______)________-_________ Email Address:__________________________
Name of Current or Last Employer: _________________________________________________________
Are you currently enrolled in a Police Academy? YES / NO
If you are currently enrolled in a Police Academy, when do you graduate? __________________
Are you currently certified through TCOLE? YES / NO
Level of TCOLE certification: ___________ Level of education achieved: ____________
Number of years of patrol experience: _____________
Are there any problems in your background that may raise a question by Kemah Police Administration as to
your qualification as an employee with the City of Kemah? YES / NO
If yes, please briefly explain on reverse side.
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