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Application For Admission

Name:_________________________________                DOB:_____________________  
Address:_______________________________                City/State/Zip___________________
Home Tel.:_______________    WorkTel:____________________________
Occupation:____________________

References: Please indicate at least two references below:
Name:_____________________________                Relationship:_________________________
Home Tel:_______________                    WorkTel:____________________________

Name:____________________________                Relationship:__________________________
Home Tel:______________                       WorkTel:____________________________

Please describe why you are interested in the Citizen Police Academy:
________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
As part of this application, we will be conducting a background check. Your signature below gives permission to the Albany PoliceDepartment to conduct this check.
Have you ever been arrested?_____ If yes, please explain:______________________________
___________________________________________________________________________

Signature:___________________________                Date:___________________

Please return to:
P.O. Fred Aliberti, Center Station,     536 Western Ave., Albany, NY, 12203
Tel: 458-5669
Fax: 458-5662