Citizen Police Academy Application
Full Name (First, Middle, Last)(*)

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Home Address(*)

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Home City(*)

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Work Address (if you do not live in Collierville)(*)

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Work City(*)

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Your profession(*)

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Phone(*)

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Email(*)

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Date of Birth (Select from calendar below)(*)


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Drivers Licene or ID number (If other than Tennessee, include state abbreviation)(*)

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Have you ever been convicted of a crime?(*)

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If yes, please explain circumstances.

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Have you been arrested within the past five years?(*)

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If yes, please explain circumstances.

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Do you have any physical limitation that would keep you from participating in this training?(*)

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Is there other information to consider regarding your application?

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By submitting this form, I authorize the Collierville Police Department to perform a background check on me (or the applicant if under age 18). I understand this background check can include searching local, state, and national databases for records that may prohibit my acceptance into the Collierville Police Citizen Police Academy class.


I have read and understood the information above.(*)

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Type what you see(*)
Type what you see

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