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POLICE ACADEMY APPLICATION WNMU Form PA 1 (Rev

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POLICE ACADEMY APPLICATION WNMU Form PA 1 (Rev POLICE ACADEMY APPLICATION WNMU Form PA 1 (rev. 09/06) Please type or use black ink and block letters. Name (Last, First, Middle) ____________________________________________ Social Security Number _____________________ Date of Birth ______________ Current Mailing Address:______________________________________________ __________________________________________________________________ Permanent Mailing Address: ___________________________________________ ___________________________________________________________________ Telephone Numbers: ____________ ___________ ______________ ___________ Home Work Cell Permanent Background and Police Contacts Read the following questions and answer each truthfully with the understanding that this information is needed to confirm your qualifications for admission. Understand that providing false information will result in dismissal from the Academy. 1. Are you a citizen of the United States? _____Yes _____No 2. Are you at least 18 years of age? _____Yes _____No 3. Do you possess a high school diploma or equivalent (GED)? _____Yes _____No 4. Do you hold a valid driver’s license? _____Yes _____No If you answer ‘yes’ to any questions numbered 5 through 20 below, please provide a full explanation on a separate sheet of paper and attach it to this application. Court disposition papers should be submitted when available. Be sure to include the details of the situation, date, location and police agency involved. This includes any juvenile offenses. 5. Have you ever been arrested for, or charged with a felony? _____ Yes _____ No 6. Have you ever been convicted of, pled guilty to, or entered a plea of nolo contendere (no contest) to any felony charge? _____ Yes _____ No 7. Have you ever been arrested for, or charged with, any crime associated with domestic violence? _____ Yes _____ No 8. Have you ever been convicted of, pled guilty to, or entered a plea of nolo contendere (no contest) to any charge of domestic violence? _____ Yes _____ No 9. Have you ever been arrested for, or charged with, driving while intoxicated or impaired? _____ Yes _____ No 10. Have you ever been convicted of, pled guilty to, or entered a plea of nolo contendere (no contest) to any charge of driving while intoxicated or impaired? _____ Yes _____ No 11. Have you ever been arrested for, or charged with, any controlled substance violations? _____ Yes _____ No 12. Have you ever been convicted of, pled guilty to, or entered a plea of nolo contendere (no contest) to any charge associated with controlled substances? _____ Yes _____ No 13. Have you ever been arrested for, or charged with any crime associated with theft or larceny? _____ Yes _____ No 14. Have you ever been convicted of, pled guilty to, or entered a plea of nolo contendere (no contest) to any charge associated with theft or larceny? _____ Yes _____ No 15. Have you ever been arrested for, or charged with, any other violation of federal or state law or municipal or county ordinance? _____ Yes _____ No 16. Have you ever been convicted of, pled guilty to, or entered a plea of nolo contendere (no contest) to any other violation of federal or state law or municipal or county ordinance? _____ Yes _____ No 18. Have you received any traffic citations in the past three years? _____ Yes _____ No 19. If yes, did you plead guilty (including mailing in penalty assessment) or nolo contendere (no contest), or were you convicted at trial? _____ Yes _____ No _____NA 20. Have you ever been pardoned, entered into a pre-prosecution diversion program or received a suspended or deferred sentence, or conditional discharge for any crime (including traffic offenses)? _____ Yes _____ No 21. Have you served in the armed forces of the United States? _____ Yes _____ No 22. If Yes, were you released or discharged under dishonorable conditions? _____ Yes _____ No _____NA (attach copy of DD-214) On a separate sheet of paper write two paragraphs that describe your career goals and why you want to attend the Western New Mexico University Police Academy. Acknowledgement I certify the information provided on this application and any attachments is true and correct to the best of my knowledge. I understand that providing false information will be grounds for dismissal from the Academy. I further understand that all release of information, waiver of liability and other application forms, affidavits, agreements or consents required by the Department of Public Safety, Training and Recruiting Division apply completely and equally to the Western New Mexico University Police Academy. I also understand that my admission to the Western New Mexico University Police Academy is conditional until I have met each and every requirement of the Department of Public Safety, Training and Recruiting Division, as well as those of Western New Mexico University. Printed or Typed Name of Applicant ______________________________ Applicant’s Signature __________________________________________ Date _____________ State of New Mexico ) County of __________________) SS. On this ______ day of ______________, 200___, before me personally appeared ___________________________ known by me to be the person whose name is subscribed to the above instrument and acknowledged the same to be his/her own act and deed. Notary Public _________________________ My Commission Expires ________________ (Seal Required) .
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