Tuesday, May 23, 2017
   
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Citizen's Academy Application
Date: (*)
Please enter a date in MM/DD/YYYY format.
Full Name: (*)
Please enter your name.
Date of Birth: (*)
Please enter a date of birth in MM/DD/YYYY format.
Address: (*)
Please enter an address.
City: (*)
Please enter a city.
State: (*)
Please enter a state.
Zip Code: (*)
Please enter a zip code.
Email: (*)
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Home Phone:
Work Phone:
Social Security Number: (*)
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Drivers License #: (*)
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Drivers License State: (*)
Please enter a drivers license state.
Occupation: (*)
Please enter an occupation.
Employer: (*)
Please enter an employer.
Employer's Address:
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Employer's City:
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Employer's State:
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Employer's Zip Code:
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Will you be able to attend all training sessions? (*)
Please select if you will be able to attend all training sessions.
If no, what conflicts will you have?
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Have you been arrested for an offense other than traffic? (*)
Please select if you have ever been arrested for an offense other than traffic.
If yes, what was the offense and when and where did it occur?
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List any civic activities/organizations you're involved in:
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What kind of experience with law enforcement have you had? (*)
Please select what kind of experience with law enforcement you have had.
Briefly Explain:
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What experiences (other than listed above) have you had with the Douglas County Sheriff's Office?
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What do you expect to gain from attending the Citizens Academy? (*)
Please enter what you expect to gain from attending the citizens academy.
Please tell us why you are interested in participating: (*)
Please tell us why you are interested in participating.


   
List One Personal or Professional Reference:
Name: (*)
Please enter the name of your reference.
Address: (*)
Please enter an address for your reference.
City: (*)
Please enter a city for your reference.
State: (*)
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Zip Code: (*)
Please enter a zip code for your reference.
Phone Number: (*)
Please enter a phone number for your reference.
Relationship: (*)
Please enter a relationship for your reference.


Person to Contact in Case of an Emergency:
Name: (*)
Please enter the name of your emergency contact.
Address: (*)
Please enter an address for your emergency contact.
City: (*)
Please enter a city for your emergency contact.
State: (*)
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Zip Code: (*)
Please enter a zip code for your emergency contact.
Phone Number: (*)
Please enter a phone number for your emergency contact.
Relationship: (*)
Please enter the relationship to your emergency contact.


   
I hereby certify the information contained in this application is true and complete to the best of my knowledge.


(*)
Please select if you acknowledge.


Information contained in this application will be used for internal information only and will not be made public.




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Sheriff Ken McGovern

Sheriff McGovern

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23.05.2017