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CERT Application

 Step 1 of 1

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

You can either complete this form online, or print off a pdf version and bring it to the Florissant Police Department.  The paper form can be found here: CERT Application

* Denotes a required field
 
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ZIP*
-
Second portion of ZIP Code is optional.
Home Phone*
-- ext
Cell Phone*
-- ext
*
*
*
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*
ZIP*
-
Second portion of ZIP Code is optional.
Employer Phone*
-- ext
Social Security Number*
--
Date of Birth*
 Date of Birth
*
Sex*
*
Do you have a valid Driver License*
*
*
Expiration Date*
 Expiration Date
*
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*
*
*
ZIP*
-
Second portion of ZIP Code is optional.
Emergency Contact Phone*
-- ext
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?*
 

Completed forms may be dropped off or mailed to the Florissant Police Department. Applications will be kept on file and you will be contacted on the next available class.