Form Center

2. 
6. PERSONAL DATA
8. First Name
9. Last Name
11. Date of Birth
12. Sex
13. Race
15. Address1
17. Address2
19. City
20. State
21. Zip
23. Home Telephone
24. Cell Number
25. Email Address
27. Driver's License Number
28. State
30. Employer
31. Occupation
33. Employer's Address
34. Community Group Affiliation
38. CRIMINAL HISTORY
40. Have you ever been arrested and convicted of a crime other than minor traffic offenses?
42. Check One

    1. YES
    2. NO
44. If yes, please explain including year of occurrence and crime:
48. EMERGENCY CONTACT
50. Name
51. Telephone Number
53. What experience have you had with Law Enforcement?
55. I CERTIFY THAT THE INFORMATION IN THIS APPLICATION IS TRUE AND COMPLETE TO THE BEST OF MY KNOWLEDGE. I ALSO GRANT PERMISSION FOR THE MOUNT PLEASANT POLICE DEPARTMENT TO VERIFY THE ABOVE INFORMATION AND CHECK FOR PRIOR CRIMINAL HISTORY.
57. SIGNATURE
58. DATE
Leave This Blank:


60. 1. Receive an email copy of this form.
61. Email address

    This field is not part of the form submission.

62. Submit Submit and Print

* indicates a required field