2. Classes run September 15 - November 17th, Thursday nights from 6:00 pm – 9:30 pm
4. West St. Paul Police Department
   1616 Humboldt Ave.
   West St. Paul, MN 55118
   Ph: 651-552-4200
   Fx: 651-552-4199
5. Mendota Heights Police Department
   1101 Victoria Curve
   Mendota Hts, MN 55118
   Ph: 651-452-1366
   Fx: 651-452-2995
7. Last Name*
8. Maiden Name
10. First Name*
11. Middle Name
13. Date of Birth*
15. Address*
16. Apt #
18. City*
19. State*
20. Zip*
22. Home Phone Number*
23. Work Phone Number
25. Email Address*
27. Are you a West St Paul / Mendota Heights resident?*

    1. Yes

    1. No
29. If you are not a resident, do you work in the City of West St Paul / Mendota Heights?

    1. Yes

    1. No
31. Business Information (if non-resident, but employee in WSP or MH)
33. Business Name
35. Street Number
36. Street Name
37. Street Type
38. Apt #
40. City
41. State
42. Zip
44. Have you ever been convicted as an adult for a criminal violation including traffic tickets?*

    1. Yes

    1. No
46. If yes, please list the date and place below. (estimated)
48. Nature of the offense(s)
50. Disposition (outcome)
52. Polo Shirt

    1. Men's

    1. Women's
54. Size

    1. Small
    2. Medium

    1. Large
    2. X-Large

    1. 1 X-Large
    2. 2 X-Large

    1. 3 X-Large
56. Copy or Picture of Drivers License*
    In order to apply online you must include a digital copy or picture of your Drivers License. If you only have a paper copy, you must apply in person.
58. Signature*

    I am over 18 years of age and I agree to allow West St Paul or Mendota Heights Police to run a Criminal Background Check on me for the purpose of determining my suitability for this program. By selecting the "I Accept" button, you are signing this Agreement electronically. You agree your electronic signature is the legal equivalent of your manual signature on this Agreement. (Please note: A criminal record does not automatically disqualify an applicant).

    1. I agree
60. Tennessen Warning
    Information requested on your application is private and may be released only to you (MS.13.04Sub2.) Private data contained include:
    
    Name: You must provide your full name. This is used to identify you from other applicants. Also using in a background check. Failure to provide this may result in a delay in processing or rejection of your application.
    
    Local / permanent address/home telephone: Used to contact you regarding your application status. You are not required to provide this information. Failure to provide this information may result in a delay of processing or notifying you of your application status, or giving credit for resident status.
    
    License Information: Used for background check. You are required to provide this information. Failure to provide this information may result in your rejection as an applicant.
    
    Date of birth: Used for background investigation and to check minimum age requirement for the program. Failure to provide this information may result in rejection of your application.
Leave This Blank:


62. 1. Receive an email copy of this form.
63. Email address

    This field is not part of the form submission.

64. Submit

* indicates a required field