SIGN UP FORM

Please fill out the form below with correct and accurate information. Applications for the next class are on a first come first serve basis. IMPORTANT: A background investigation on you will be conducted upon submission of this application. Any criminal convictions, any previous actions which could reflect unfavorably on the Miami Beach 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. Please fill in all fields marked with a *

Today's Date*
Email Address*
First Name*
Middle Name
Last Name*
Date Of Birth*
Sex*	Female Male
Race*	White Black Other
Address* No P.O. Boxes
City*
State*
Zip*
Home Phone*
Cell or Alternate Phone*
Ever Been Arrested*	Yes No If yes, you must fax the following information to Lori at 305-604-2282 in order to be considered as a student: Copy of arrest form showing clearly the arresting agency, their case number and the charges, and a copy of court documents showing the outcome of the charges.
If Yes, Please explain the circumstance
Any Physical Limitations
Why I want to attend
Emergency Contact*

By submitting this information to the Miami Beach Citizens Police Academy and Miami Beach Florida Police Department you swear that the above information is true. You understand and agree that a thorough background check will be done and that you understand you will be contacted by a represenative of the Miami Beach Citizens Police Academy to inform you of your enrollment status. You understand that by sending this form you are NOT guaranteed a spot in any of the classes. If you have any questions or problems in regards to the program before you submit please contact the class coordinator.

THIS IS NOT AN APPLICATION TO BE A POLICE OFFICER.