[County of Kauai] Explorer Application

Kauai Police Department
Explorer Post 2049

Social Security Number *

Birthdate *

Gender *

Cell Phone *

Home Phone *

School *

Grade *

GPA *

Employment

Place of Employment

Position/Duties

Work Hours

Health Insurance Provider

Social Media Accounts

Accounts

Type of Account (ex. Facebook or Instagram)

User Name

Type of Account

User Name

Type of Account

User Name

Emergency Contact Information

Emergency Contact 1

Parent/Guardian Name *

Cell Phone *

Home Address

Home Phone

Place of Employment *

Work Number *

Emergency Contact 2

Parent/Guardian Name *

Cell Phone *

Home Address

Home Phone

Place of Employment *

Work Number *

Personal References

*** You must list 3 references not related to you ***

Reference 1

Name

Address

Place of Employment

Phone Number

Reference 2

Name

Address

Place of Employment

Phone Number

Reference 3

Name

Address

Place of Employment

Phone Number

Explain your interest in Law Enforcement and your reason for wanting to become a member of the Kauai Police Department Explorer's Program. Also list which activities you would like to participate in if selected to be a member.