Commonwealth's Attorney Community Academy Application

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* 1. Applicant Information

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:

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* 2. Preferred Email Address:

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* 3. Race:

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:

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* 4. Month

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* 5. Date:

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* 6. Year:

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* 7. Sex

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* 8. Driver's License Number:

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* 9. Driver's License State:

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* 10. Occupation:

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* 11. Employer:

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* 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.