Mountain Home Police Dept.
103 W. 9th Street
Mountain Home, AR
72653

870-425-6336

Email

<p align="center"><font size="2"><strong>MOUNTAIN HOME POLICE DEPARTMENT</strong></font></p><p align="center"><font size="2"><strong>Citizens Police Academy</strong></font></p><p align="center"><font size="2"><strong>Application Form</strong></font></p><p>All applicants must be at least 21 years of age. A background check will be done on each applicant. The Mountain Home Police Department reserves the right to deny entry to the academy based on the findings of a background check. </p><p>By providing an electronic signature at the end of this form states that all information on this form is accurate to the best of your knowledge. Your electronic signature authorizes the Mountain Home Police Department to conduct a background check for admission to the academy.</p><address></address><address></address><div align="center"><address></address></div> By providing an electronic signature at the end of this form states that all information on this form is accurate to the best of your knowledge. Your electronic signature authorizes the Mountain Home Police Department to conduct a background check for admission to the academy.

Last Name
First Name
Middle Name
Street Address
City
State
Zip Code
Date of Birth
Telephone Number (day)
Telephone Number (evening)
Email Address
Occupation
Employer
Length of Employment
Personal references we may contact		Provide name, address, and phone number
Have you ever been arrested or issued a citation?		Yes or no: if yes, provide details
Have you ever been convicted of a criminal offense?		Yes or no: if yes, provide details
Signature		Typing your name here serves as an electronic signature
Todays Date