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2. Date*
   Date
4. First Name*
5. Last Name*
7. Driver's License #
8. Date of Birth*
10. Address1*
12. City*
13. State
14. Zip
16. Phone Number*
17. Email Address
19. Have you ever been arrested for anything other than a minor traffic violation?
21. Yes / No*
22. If Yes, Please Explain-
24. If Physical Condition is Limited, Please Explain-
26. "I want to attend the Citizens Police Academy because"
28. Emergency Contact- Name, Phone Number, Relationship*
30. I understand that a background investigation will be conducted upon submission of this application. Any criminal convictions, any previous actions which could reflect unfavorably on the Muskego Police Department, any suggestion that I might be a security risk, or any attempt to deceive or conceal pertinent information, will be cause for denial of this application.
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32. 1. Receive an email copy of this form.
33. Email address

    This field is not part of the form submission.

34. Submit

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