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2. First Name*
3. Last Name*
5. Address1*
7. Address2
9. City*
10. State*
11. Zip*
13. Phone Number*
14. E-Mail*
16. Driver's License Number*
17. Driver's License State*
19. Will you be claiming Veteran's preference?*

    1. Yes
    2. No
21. Will you be at least 21 years of age on or before testing?*

    1. Yes
    2. No
23. Do you have Pennsylvania ACT 120 MPOETC Certification?*

    1. Yes
    2. No
25. Are you currently attending a Pennsylvania ACT 120 MPOETC Academy?*

    1. Yes
    2. No
27. I have read the Physical Fitness Standards and understand I will be required to pass the assessment in order to participate in the Written Test. *

    Click here to review the Physical Fitness Requirements.

    1. Yes
    2. No
29. I have read the Essential Job Functions of a Police Officer and am able to perform all of the listed functions.*

    Click here to review the duties of a police officer.

    1. Yes
    2. No
31. I hereby attest that all the information set forth on this application is true and correct to the best of my knowledge. I understand that the statements made herein are subject to the penalties of PA Title 18, Section 4904, relating to Unsworn Falsification to Authorities. *

    1. Yes
    2. No
33. I hereby release the West Chester Police Departmnent and its member agencies, officials, employees, and agents from any liability for injuries or death which may occur as a result of my participation in the police officer physical agility tests. *

    1. Yes
    2. No

37. PLEASE READ

    There is a non-refundable $40.00 registration fee. You will be able to pay this fee online once you submit your registration. 

    To pay this fee by cash or check you must appear in person at the West Chester Police Department, between Monday and Friday, 8AM to 4PM prior to May 6, 2022.

    When paying online be sure to enter the name of the registrant in the "Provide your contact info" fields when making the payment.

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39. 1. Receive an email copy of this form.
40. Email address

    This field is not part of the form submission.

41. Submit

* indicates a required field