[County of Kauai] Citizens Police Academy

Kauai Police Department

Citizens Police Academy

(Information is confidential and for KPD use only)

Gender

Date of Birth *

Social Security Number *

Occupation *

Employer *

Contact Numbers

Mobile

Home

Business

Education Information

High School- Last Grade Completed

College - Years Completed

Degree / Major

Have you been arrested or convicted of a crime in the last six years?

Yes

If Yes, please explain

Why do you wish to attend the Citizens Police Academy?

List two references, not related to you

Reference 1

Name *

Address *

Phone *

Reference 2

Name *

Address *

Phone *

I give the Kauai Police Department permission to verify information provided

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First Name

Last Name

Choose how to sign

Draw Type

I give the Kauai Police Department permission to verify information provided