Please note, this is class is presented in Spanish. Future classes will be scheduled and presented in English.

Please complete the following form to apply for the next Community Police Academy which starts on March 22, 2023. This is a 10 week program, and meets every Wednesday night from 6pm to 9pm. There is no cost to attend, and you must be 18 years of age to apply.

- You must be at least 18 years of age

- You should live or work in the City of San Rafael

- You must not be convicted of a felony, or prohibited from owning or possessing a firearm

- Applications must be received by February 2, 2023

** This application is for the next class, which begins March 22, 2023 **

Applicant Information:

First Name:
Middle Name:
Last Name:
Alias:
Date of Birth:	(You must be at least 18 years of age)
Address:
City:
State:
Zip Code:
Home Phone:
Office Phone:
Other Phone:
Email Address:

Drivers License Number:
Drivers License State:
Drivers License Class:
Drivers License Expiration Date:
Is your Drivers License Currently Valid?	YES NO

Have you ever been convicted of any felony?YES NO
If yes, please explain where, when, and disposition:

Place of Employment:
Employer Address:
Duties Performed:

How do you feel the community police academy will benefit you?

What is your opinion of the San Rafael Police Department?

I hereby certify that the answers are true and correct. By pressing "Submit", I authorize any of the academy law enforcement agencies to do a criminal history and background check for the purposes of this academy.

Protecting the Mission City