Police Explorer Application

"*" indicates required fields

Phone

This field is for validation purposes and should be left unchanged.

First Name:*

Last Name:*

Age:*

You must be 14 or older

Date of Birth*

Address:

Street Address City State / Province / Region ZIP / Postal Code

Home Phone:

Cell Phone:

Current High School/College attending:

Grade/Level:*

GPA:

If graduated – High School last attended:

High School Diploma

Yes

GED:

Yes

Name of Company:

Current Employer (or most recent)

Position:

Working:

Full-Time

Part-Time

Date Started:

Date Ended:

Please list any medical conditions you have:

Have you ever been arrested, charged with a crime, or listed as a suspect in a criminal case?

Yes

If yes, what were the charges or circumstances?

If yes, by what Police Department/Agency:

What was the outcome of the charge? (Dismissed, probation, Community Service, etc.)

Parent/Guardian Name:

Home Address:

Street Address City State / Province / Region ZIP / Postal Code

Home Phone:

Cell Phone: