Application

PERSONAL HISTORY

FULL NAME:
RESIDENCE ADDRESS:
CITY: STATE: ZIP:
PHONE: EMAIL:
DATE OF BIRTH: AGE: SEX:
WEIGHT: HEIGHT:
EYE COLOR: HAIR COLOR:
DRIVERS LICENSE/PERMIT NO: STATE:
ARE YOU A U.S. CITIZEN?
HOW LONG HAVE YOU LIVED IN FL?

FATHERS NAME:
EMPLOYER: WORK PHONE:
ADDRESS:
CITY: STATE: ZIP:
HOME PHONE:

MOTHERS NAME:
EMPLOYER: WORK PHONE:
ADDRESS:
CITY: STATE: ZIP:
HOME PHONE:

SCHOOL INFORMATION

CURRENT SCHOOL ATTENDING: YEAR:
GPA: DATE OF GRADUATION:
IF APPLICABLE, HIGH SCHOOL LAST ATTENDED:

(PLEASE ANSWER YES OR NO FOR THE FOLLOWING 2 QUESTIONS)
HIGH SCHOOL DIPLOMA:
GED:
WHAT ARE YOUR CAREERS GOALS AT THIS POINT?

YOUR HIGH SCHOOL GUIDANCE COUNSELOR'S NAME:

(PLEASE ANSWER YES OR NO FOR THE FOLLOWING 5 QUESTIONS)
HAVE YOU EVER BEEN SUSPENDED?
HAVE YOU EVER SKIPPED CLASS OR OTHERWISE BEEN ABSENT FROM SCHOOL WITHOUT PERMISSION?
HAVE YOU EVER BEEN ARRESTED?
HAVE YOU EVER BEEN DETAINED BY A LAW ENFORCEMENT OFFICER?
HAVE YOU EVER COMMITTED OR BEEN INVLOVED IN A CRIMINAL OFFENSE FOR WHICH YOU WERE NOT ARRESTED OR CHARGED?

IF YOU ANSWERED YES TO ANY OF THE ABOVE QUESTIONS, PLEASE EXPLAIN IN DETAIL:

LIST ANY MEMBERS OF THE VENICE POLICE DEPARTMENT OR OTHER AGENCY WHOM YOU KNOW PERSONALLY OR TO WHOM YOU ARE RELATED. PLEASE STATE NAME AND RELATIONSHIP TO YOU:

LIST ANY MEMBER OF THIS EXPLORER POST WHOM YOU KNOW PERSONALLY:

HOW DID YOU FIND OUT ABOUT THE VENICE POLICE EXPLORERS:

REFERENCES

LIST TWO ADULT MEMBERS OF THE COMMUNITY WHOM YOU CAN USE AS A CHARACTER OR JOB REFERENCE. DO NOT INCLUDE PARENTS OR RELATIVES:

NAME:
ADDRESS:
HOME PHONE: WORK PHONE:
RELATIONSHIP: YEARS KNOWN: