Please email: kboschert@florissantmo.com with the following information:

Carefully answer each question accurately. An applicant may be disqualified from attending the Citizen Academy if he/she intentionally makes a false statement of material fact or practices or attempts to practice any deception or fraud in this application.

Last Name First Name Middle
List all other names you have used, including maiden names, nicknames and aliases:
Address City State Zip
Occupation Employer
Address City State Zip
Employer Phone Number Home Phone Number
Date of Birth Age Sex
Are you a U.S. citizen? Yes No
Social Security Number
Do you have a valid Driver License Number? Yes No
Driver License Number State Issued Expiration Date
Have you ever been arrested, detained or taken into custody in this state, any other state, in the military, or any other entity for any reason at all? Yes No
If yes, please explain: Indicate the date, violation charged, location, court disposition, police agency involved, and report (case) number of incident .