Police Explorers Program Police Department | Explorers Program Application First Name:* Last Name:* Age:* You must be 14 or olderDate of Birth*Month123456789101112Day12345678910111213141516171819202122232425262728293031Year2025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Address: Street Address City State / Province / Region ZIP / Postal Code Home Phone:Cell Phone:Email Education InformationCurrent High School/College attending: Grade/Level:*Select one:8th Grade9th Grade10th Grade11th Grade12th GradeGraduatedGPA: If graduated – High School last attended: High School Diploma Yes No GED: Yes No Employment InformationName of Company: Current Employer (or most recent)Position: Working: Full-Time Part-Time Date Started: MM slash DD slash YYYY Date Ended: MM slash DD slash YYYY Medical Information:Please list any medical conditions you have:Additional Information:Have you ever been arrested, charged with a crime, or listed as a suspect in a criminal case? Yes No 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 Information (if under 18)Parent/Guardian Name: Home Address: Street Address City State / Province / Region ZIP / Postal Code Home Phone:Cell Phone:Email PhoneThis field is for validation purposes and should be left unchanged.