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  Applicants must be at least 18 years of age and a resident of, or employed in Jefferson County. Any incorrect and/or unsigned applications WILL NOT be considered.
   
1.
Last, First M.I.
 
   
2.
  Select Date
mm/dd/yyyy
   
3.
 
   
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City of Beaumont?  
City of Port Arthur?  
Jefferson County?  
Do you own a business in Jefferson County?  
   
11.
 
   
  PLEASE REVIEW YOUR ANSWERS CAREFULLY AND READ THE STATEMENT BELOW BEFORE SIGNING THIS APPLICATION.
   
  I hereby certify that there are no willful misrepresentations, omissions, or falsifications in the forgoing statements and answers to questions. I understand that any omissions or false statements on this application shall be sufficient cause for rejection from the enrollment or dismissal from the Citizens Police Academy.

I further understand that a law enforcement agency participating in the Citizens Police Academy will be conducting a thorough background investigation that may include, but will not be limited to, any criminal history, employment history and/or personal references.
   
12.
(Email Address is your electronic signature)
 
   
13.
  Select Date
mm/dd/yyyy
   
  If you have any questions, contact PCR at (409)880-3825.
   
 
 
 
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