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Commonwealth's Attorney Community Academy Application
*
1.
Applicant Information - (
all fields are required, put "N/A" if the question is not applicable to you)
(Required.)
Last Name:
First Name:
Middle Name or Initial:
Street Address:
City:
State
Zip Code:
Preferred Phone:
Work Phone:
Last Four Digit of SSN:
Business Address:
*
2.
Preferred Email Address:
(Required.)
*
3.
Race:
(Required.)
White or Caucasian
Black or African American
Hispanic, Latino or Spanish origin
Asian
American Indian or Alaska Native
Native Hawaiian or other Pacific Islander
Middle Eastern or North African
Some other race, ethnicity, or origin
Date of Birth:
*
4.
Month
(Required.)
January
February
March
April
May
June
July
August
September
October
November
December
*
5.
Date:
(Required.)
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
*
6.
Year:
(Required.)
1939
1940
1941
1942
1943
1944
1945
1946
1947
1948
1949
1950
1951
1952
1953
1954
1955
1956
1957
1958
1959
1960
1961
1062
1963
1964
1965
1966
1967
1968
1969
1970
1971
1972
1973
1974
1975
1976
1977
1978
1979
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
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7.
Sex
(Required.)
*
8.
Driver's License Number:
(Required.)
*
9.
Driver's License State:
(Required.)
*
10.
Occupation:
(Required.)
11.
Employer:
12.
Do you have any current or past involvement with a case prosecuted by the Office of the Commonwealth’s Attorney and/or investigated by the Alexandria Police Department? If so, please describe briefly.
