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2. 

3. County & District Attorney

   
   

     Prosecutor Academy

   
   

   Application

7. The Ellis County & District Attorney's Office is a law enforcement agency, and does a thorough background, criminal history, social media and references check of all applicants. The Office has the final authority on the selection of participants.

9. Date of Application*
11. First Name*
12. Last Name*
14. Address 1*
16. Address 2
18. City*
19. State*
20. Zip*
22. Driver's License Number and State*
23. Date of Birth*
25. Home Phone*
26. Cellular Phone*
28. Employer and Occupation*
30. Please list any community/civic organizations or activities in which your are currently involved:*
32. What do you hope to gain through your participation in this program?*
34. How did you hear about the program?*
36. Please disclose your username or URL for ALL social media accounts you have online.*
38. Please list your educational background.*
40. Do you live in Ellis County?*
    -- Select One --YesNo
42. If yes, how long have you lived in Ellis County?
44. Have you ever been arrested for any offense, regardless of disposition?*
    -- Select One --YesNo
46. If you answered yes, please provide details including what the charge was, the date and location of the offense, and the outcome of any charges.
48. Does any family member have a pending criminal charge?*
    -- Select One --YesNo
50. If you answered yes, please provide details including the charge, the date and location of the offense, and whether the family member is currently placed on regular or deferred adjudicaiton.
52. Are you currently serving on a jury?*
    -- Select One --YesNo
54. Have you received a Jury Summons for a future date?*
    -- Select One --YesNo
56. References (please provide 3)
58. First Name*
59. Last Name*
61. E-Mail Address*
62. Phone*
66. First Name*
67. Last Name*
69. E-Mail Address*
70. Phone*
74. First Name*
75. Last Name*
77. E-Mail Address*
78. Phone*

80. CERTIFICATION

    
    I hereby certify that there are no willful misrepresentations, omissions, or falsifications in the foregoing statements and answers to questions. I understand that any omission or false statements on this application shall be sufficient cause for rejection for enrollment or dismissal from the Ellis County & District Attorney Citizen Prosecutor Academy. I further understand that the Ellis County & District Attorney will be conducting a thorough background investigation that may include, but is not limited to, criminal history, employment history, social media history and personal references. I declare that I have never been convicted of a felony offense in this state or in any other state within the United States. I also understand that any participant may be removed from the Ellis County & District Attorney Citizen Prosecutor Academy if said participant is disruptive or otherwise inhibits the concept or implementation of this program.

82. Applicant's Signature*
83. Date*
85. Email Address*

87. ***Please include a copy of your driver's license and submit it with your application***

89. Copy of Driver's License*
Leave This Blank:


91. 1. Receive an email copy of this form.
92. Email address

    This field is not part of the form submission.

93. Submit

* indicates a required field