Name:

*First Name

*Last Name

*I am at least 18 years of age or older?

Address:

*Address

*City

*State

*Postal Code

Contact:

*Phone #

*Email address

*OH Driver's License #

Employment Information:

*Present Employer

*Employer Address

*Occupation

*Length of Employment

Criminal History:

*Have you ever been arrested for, convicted of, or cited for an offense other than traffic citations? (Yes/No) If yes, explain in detail showing the date, charge, location, and action taken:

Yes

If yes above, explain in detail showing the date, charge, location, and action taken:

Tell us about you:

*Briefly explain why you wish to be enrolled in the Sheriff’s Citizen Academy:

*List your community involved activities:

References:

Please list two (2) character references who are not family members or employers:

Reference 1:

*Reference 1 Name:

*Reference 1 Address:

*Reference 1 Phone Number:

Reference 2:

*Reference 2 Name:

*Reference 2 Address:

*Reference 2 Phone Number:

Shirt Size:

Please indicate the shirt size you would prefer.

*Shirt Size

PLEASE REVIEW YOUR ANSWERS CAREFULLY AND READ THE STATEMENT BELOW BEFORE SIGNING THIS APPLICATION.

I HEREBY CERTIFY THERE ARE NO WILLFUL FALSIFICATIONS, OMISSIONS, OR MISREPRESENTATIONS IN THE FOREGOING STATEMENTS AND ANSWERS TO QUESTIONS. I UNDERSTAND ANY OMISSION OR FALSE STATEMENT ON THIS APPLICATION SHALL BE SUFFICIENT CAUSE FOR REJECTION FOR ENROLLMENT IN OR DISMISSAL FROM THE SHERIFF’S CITIZEN ACADEMY.

I UNDERSTAND THE INFORMATION CONTAINED IN THIS APPLICATION IS CONSIDERED A PUBLIC RECORD AND MAY BE RELEASED TO THE MEDIA OR OTHERS UPON THEIR REQUEST. I ALSO UNDERSTAND I MAY BE PHOTOGRAPHED OR VIDEOTAPED BY THE NEWS MEDIA, OR THE UNION COUNTY SHERIFF’S OFFICE DURING THE COURSE OF THIS PROGRAM. THESE PICTURES OR VIDEOTAPES MAY BE USED FOR NEWS RELEASES AND INFORMATION PROMOTIONS.

DUE TO THE CURRICULUM CONTENT, SOME CLASSES REQUIRE WALKING AND STANDING FOR A PERIOD OF TIME AS DIFFERENT LAW ENFORCEMENT ACTIVITIES WILL BE DEMONSTRATED. PLEASE INFORM US OF ANY CONSIDERTIONS OR ACCOMMODATIONS YOU MAY NEED WHILE PARTICIPATING IN THE CITIZEN ACADEMY. .

*I certify the above:

Confirm

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