Lompoc Police Department. Self Defense Course Application Form. Contact information will be used to contact applicants r
Lompoc Police Department
Self Defense Course Application Form Contact information will be used to contact applicants regarding course information and participation.
Applicant Information Full Name: First and Last
Address: Street Address
Apartment/Unit #
City
Home Phone:
(
State
ZIP Code
)
DOB:
Email:
Voluntary Information This information is for statistical purposes only. The information is voluntary and will not be used to determine acceptance of application. Information is confidential. Racial or Ethnic Group ☐
American Indian/Alaskan
☐
Asian/Pacific Islander
☐
Black/African American
☐
Hispanic/Latino
☐
White/Caucasian
☐
Other
☐
Male
Gender ☐
Female
How did you hear about this position? ☐
Newspaper
☐
Flier
☐
Other
☐
City Employee
. Please tell us why you are interested in participating in this course.
