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Citizens Police Academy Enrollment Application

Please correct the field(s) marked in red below:

1
Contact Information:
 *
Contact Information:
2
Do you live or work in Johnson County?
Do you live or work in Johnson County?
3
How did you hear about the academy?

Background Information:
4
Please explain why you wish to attend the Citizens Police Academy.
5
Have you ever been arrest, convicted of or cited for an offense other than a traffic violation?
Have you ever been arrest, convicted of or cited for an offense other than a traffic violation?
6
Have you been party to a civil lawsuit in the past 10 years?
Have you been party to a civil lawsuit in the past 10 years?
7
Employment:
Employment:
8
May we place your name, address and phone number on a class roster?
May we place your name, address and phone number on a class roster?
9
Emergency Contact:

10

Certification and Signature

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 statement on this application shall be sufficient cause for rejection of enrollment  or dismissal from the Johnson County Sheriff’s Citizen Police Academy. I understand that participation in this program is not to train students to become police officers. Participation is to provide education regarding the purpose, rational and context of police procedures. I acknowledge that as part of acceptance in this program, I will be required to attend at least 70 percent of the classes. Failure to attend will be cause for dismissal from this program. I will abide by all rules and regulations set forth by the Johnson County Sheriff’s Office,  and will provide my own transportation and insurance. I further understand that the Johnson County Sheriff’s Office will conduct a thorough background investigation that may include criminal history information, employment history and personal references. The Johnson County Sheriff’s Office reserves the right to deny any application.

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Certification and Signature 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 statement on this application shall be sufficient cause for rejection of enrollment or dismissal from the Johnson County Sheriff’s Citizen Police Academy. I understand that participation in this program is not to train students to become police officers. Participation is to provide education regarding the purpose, rational and context of police procedures. I acknowledge that as part of acceptance in this program, I will be required to attend at least 70 percent of the classes. Failure to attend will be cause for dismissal from this program. I will abide by all rules and regulations set forth by the Johnson County Sheriff’s Office, and will provide my own transportation and insurance. I further understand that the Johnson County Sheriff’s Office will conduct a thorough background investigation that may include criminal history information, employment history and personal references. The Johnson County Sheriff’s Office reserves the right to deny any application.
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