Kenneth C. Thompson Institute of Public Safety
Pre- Screening Application
Name: __________________________________________________________________
(Last) (First) (Middle)
Physical Residence: _______________________________________________________
________________________________________________________________________
Mailing Address (If Different): ______________________________________________
________________________________________________________________________
Telephone Numbers: Home: ______________________ Work: ____________________
Cell: _______________________ Email Address: ______________________________
Social Security #: ________________________ Date of Birth (DOB) _______________
Drivers License: # ___________________________ State: ____ Expiration: __________
I am a citizen of the United States. ________
Naturalization Certificate #:________________ Country of Origin: _________________
Answer the following questions. If you answer “yes” to a question, that has a space for an
explanation, provide a brief summary. Based on your answers to the questions it may result in
your disqualification from attending our academy. Answering yes to any question does not
necessarily disqualify you. Be honest and if the selection center coordinator needs more
information you will be contacted.
After your pre-screening form is reviewed, and you meet the minimum qualifications a full
application will be emailed to you and an appointment will be scheduled with the selection
center coordinator to start the application process for acceptance into the academy.
1. Do you have a high school diploma or equivalent?
2. If you served in the U.S. military did you receive an honorable discharge?
3. Have you ever been arrested?
Explain:
