Municipal Police Officers' Training Academy Statement of Interest

Complete all sections. Submission of statement of interest is no guarantee of acceptance into the program.

Personal Information

Preferred Enrollment Status

Full-Time

Part-Time

First Name

Middle Name

Last Name

Email Address

Sex

Home Phone

Cell Phone

Work Phone

Legal Address

Address Line 1

Address Line 2

City

State/Province

ZIP/Postal Code

County

Is your mailing address the same as your legal address?

Yes

Mailing Address

Address Line 1

Address Line 2

City

State/Province

ZIP/Postal Code

Education

Did you attend high school?

Yes

High School Name

City

State/Province

Did you graduate?

Yes

When did you graduate?

Were you home schooled?

Yes

Date of Completion

In what state did you or will you complete your homeschooling?

Do you have a GED?

Yes

Date GED Received

Did you attend a university/college or Vo-Tech school?

Yes

College/Vo-Tech Name

City

State/Province

Degree Earned

Dates Attended

College/Vo-Tech Name

City

State/Province

Degree Earned

Dates Attended

College/Vo-Tech Name

City

State/Province

Degree Earned

Dates Attended

College/Vo-Tech Name

City

State/Province

Degree Earned

Dates Attended

College/Vo-Tech Name

City

State/Province

Degree Earned

Dates Attended

College/Vo-Tech Name

City

State/Province

Degree Earned

Dates Attended

College/Vo-Tech Name

City

State/Province

Degree Earned

Dates Attended

College/Vo-Tech Name

City

State/Province

Degree Earned

Dates Attended

Employment

Are you currently employed?

Yes

Current Employment

Position

City

State/Province

Date of Hire

Are you currently employed by law enforcement agency?

Yes

Department Head

Telephone

Employment Status

Full-Time

Part-Time

Were you an MP in the military?

Yes

History

Have you ever been charged with or convicted of a crime?

Yes

If YES, please explain:

Are you currently under a doctor's care or on any medication?

Yes

If YES, please explain:

Do you suffer any physical/mental disabilities which may interfere with your police academy training?

Yes

If YES, please explain:

Have you ever received counseling/treatment for drug/alcohol abuse/addiction?

Yes

If YES, please explain:

Mansfield University is committed to enhancing the diversity of its employees and student body, and provides equal opportunities for employment and advancement for all individuals regardless of race, color, religion, sex, disability, ancestry, national origin, age, sexual orientation, gender identity/expression, genetic background or veteran status. As an Equal Opportunity Employer, Mansfield University is committed to providing a diverse working and learning environment and welcomes applications from all qualified candidates. AA/EOE For further information, call the Affirmative Action Officer at (570) 662-4892.

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