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Citizen's Police Academy Application

  1. Last, First Middle
  2. (Home)
  3. (Cell)
  4. May We Contact?
  5. Have You Ever Served in the U.S. Armed Services?
  6. Type of Discharge
  7. Please furnish 3 personal references. Do not list relatives or previous employers. These references must have known you for at least 2 years. Please provide all requested information, do not leave any blanks.
  8. Have You Ever Been Arrested, Indicted, Issued a Summons to Appear, or Otherwise Charged With a Crime?
        (Include Juvenile Arrests)
      1. Have You Ever Been Found Guilty or Plead No Contest to a Crime, Including Arrestable Traffic Offenses?
            (e.g. Driving While Intoxicated, Reckless Driving, Driving Revoked, Etc.)
          1. Certification
            I agree to submit to the department’s selection process and understand that I must successfully complete this process before given final consideration for acceptance into the Citizen Police Academy.

            I hereby authorize my employer, educational institutions, and any other persons or individuals to furnish any information concerning me, whether or not it is on their records, and I release them and their companies from any liability whatsoever. I certify that all statements given on this application are true and correct. I realize that falsification or misrepresentation on this or any other personnel record may result in my not being accepted into the Citizen Police Academy. Also, in the event of acceptance and in consideration thereof, the Mitchell Police Division and any person or entity it may authorize, shall be entitled, without further consent, to use, in any manner required, any picture or photograph of me or a recording of my voice.
          2. Leave This Blank:

          3. This field is not part of the form submission.