Join the Citizens Academy

First Name *

Middle Name *

Last Name *

DOB (mm/dd/yy) *

Month

Day

Year

Address *

City *

State *

Zip *

Home Phone *

Cell Phone

Your Email Address *

Occupation

Employer

Employer Address

Employer State

Employer Zip

Business Phone

Drivers License Number *

Driver's License State *

Do you have any law enforcement experience?

Yes"

No"

If Yes, please explain:

Have you ever been arrested or adjudicated for a crime other that a traffic violation?

Yes"

No"

If Yes, provide details of arrest(s) and/or conviction(s):

Please Provide one character reference, other than a relative, who has known you for at lease three (3) years.

Reference First Name

Reference Middle Name *

Reference Last Name *

Years Acquainted *

Reference Address *

Reference City *

Reference State *

Reference Zip *

Reference's Occupation *

Reference's Employer *

Reference's Home Phone *

Reference's Business Phone *

Reference's E-Mail Address *

Do you have any special needs? (hearing impaired, etc.)

Please list any Citizens Academies you have attended in the past.

How did you hear about the Sheriff's Citizens Academy and why do you want to attend?

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Join the Citizens Academy