Application Form

Full legal name: First, Middle, Last

Phone

Permanent Street Address:

City:

State:

Zip:

I am applying for:

Year:

I am applying as:

Are you currently a degree seeking student at a college or university?

University or college name and location:

Current major (and minor):

Status:

GPA:

Have you been honorably discharged from the U.S. military and are you eligible for educational benefits under the GI Bill?(required)

Yes

What are your reasons for wanting to enroll in the Park Ranger Law Enforcement Academy in Flagstaff, AZ?

List any relevant work experience that you may have in the fıelds of park management, resource management, law enforcement or recreation

List your special interests and hobbies

Describe your abilities and skill in interpersonal communication, professional attitude, and physical fitness.

Criminal Offense Disclosure.Have you ever been (check all that apply):

Arrested

Charged with a crime by any law enforcement authority

Convicted of any offense against the law (includes “no contest” or “nolo contendere”)

Charged with any motor vehicle moving violation

Involved in a motor vehicle collision/accident

Subject to forfeiture of collateral in connection with an arrest

Imprisoned

Placed on probation

Required to appear before a juvenile court for an act that would have been a crime if committed by an adult

If you checked the box for any of the above, give complete details in this field. Include, as a minimum, the date of the offense, charge(s), city and state, name of law enforcement agency involved, and final disposition.

Are you now: (check all that apply):

Charged with an offense by any law enforcement authority

Presently out on bail or out on personal recognizance or other conditional release

On probation of any type

Additional self disclosure: Have you ever been: (check all that apply):

Diagnosed as having a mental or emotional disorder

Associated in any manner with any group that advocates resistance and/or violence or attempts to overthrow the United States Government

Been fired from any job or resigned in lieu of termination

Provide 3 references. Include for each: Name, Title, Relationship to you, and Telephone number

Reference #2

Reference #3

Payment: A non-refundable $150 fee is required for processing applications to the academy. Your application will not be considered until this payment is received. Credit or debit card payments can be made by phoning the academy’s administrative assistant at 928-523-5392. Checks or money orders must be made out to “Northern Arizona University” and mailed to: Michael O’Connor, Director, Park Ranger Law Enforcement Academy, Northern Arizona University, PO Box 15016, Flagstaff, AZ 86011-5016. If paying by check or money order, include the check or money order number below.

Check or money order number:

Acknowledgement (required)

By submitting this form I attest that the information I have provided is true and correct. I understand that any misleading or false information is just cause for refusal of this application. I also understand that if I am admitted to the academy any submission of false information will result in my dismissal from the Park Ranger Law Enforcement Academy.

Park Ranger Law Enforcement Academy, Flagstaff, Arizona

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