Citizen Police Academy Application

Roanoke Citizen Police Academy Application

Basic Academy Advanced Academy Senior Academy

Date
Full Name	Mr. Mrs. Ms.
Addess
Date of Birth
Social Security Number	We will contact you for this information.
Home Phone Number
Work Phone Number
E-mail Address
Occupation
Employer
Years Employed (current employer)
Former Employers
Education	Please include level and school attended.
Special Training
Two Character References	Please provide names and addresses.
List any Roanoke Police Officers you know.
Will you be able to attend all classes? If not, please explain.
Are you involved in the community? If so, how?
Why do you want to participate in the Citizen Police Academy?
What do you hope to gain from this program?
If you are not selected for this class, would you be interested in attending a future academy?	Yes No
How did you first hear about the Citizen Police Academy?
	By checking the box below, I hereby make application for the Citizen Police Academy sponsored by the Roanoke Police Department. I understand that a standard background check will be made using the information I have provided, including a criminal history and DMV history. I also understand that a “RIDE ALONG PROGRAM”, DEFENSIVE TACTICS DEMONSTRATION, FIREARMS DEMONSTRATION and OPERATION OF A POLICE VEHICLE are part of the Citizen Police Academy and that I will be required to complete the necessary waivers provided by the Roanoke Police Department. I hereby certify that all statements made in this application and any attachments are true and complete to the best of my knowledge, and I understand that any misstatement of material facts may subject me to disqualification or dismissal. I agree to the above statements.