Sheriff's Citizens Academy Application

Name *

First

Last

Home Address *

Address Line 1

Address Line 2

City

State

Zip Code

Please list any other names you have used: *

Sex: *

Date of Birth: *

Place of Birth: *

Driver's License Number: *

Driver's License State: *

Telephone Phone Number: *

Email Address: *

Employer: *

Employer Address: *

Position at Employer: *

Criminal History: Have you ever been arrested or convicted of a crime other than traffic offenses? *

If you answered "Yes" please explain:

Reference *

First

Last

Please list a personal reference (NOT a relative):

Reference Telephone Phone Number: *

Reference Relationship to Applicant *

If you are currently active with any neighborhood, community, or civic organization, please list below: *

Have you applied for the Sheriff’s Citizens Academy in the past? *

If you answered "yes", when? *

Please complete a short explanation as to why you wish to participate in the Franklin County Sheriff’s Office Citizens Academy: *

Notice to Applicants

Applicants must be 25 years of age
Applicants must be Franklin County residents
Applicants must have NO prior felony convictions
Applicants must have NO misdemeanor arrests within the past 36 months prior to the academy start date.
Incomplete applications will NOT be processed

Confirmation of Notice to Applicants *

I have read the Notice to Applicants and confirm that I meet all requirements to participate in the program.

Background Check Authorization

This document constitutes a Consent, Release / Agreement of Indemnification and permission to conduct a background check entered on the date provided below and signed by the applicant.

As an applicant to the Franklin County Sheriff’s Office Citizens Academy, I hereby authorize the Franklin County Sheriff’s Office to conduct a criminal background investigation.

I understand that all available police and criminal records will be checked by this office and will be used to determine my eligibility for the Sheriff’s Citizens Academy. All information obtained will remain confidential in accordance with the law.

Authorization of Background Investigation *

I have read the Background Investigation Release and agree to the background investigation required to participate in the program.

Release Form

The undersigned, in consideration for the privilege of being a participant in the Sheriff’s Citizens Academy, and recognizing that such activity involves certain inherent risks and dangers, does hereby agree to assume the risks attendant to all activities associated with the participation in the Sheriff’s Citizens Academy Program.

Confirmation of Release Form *

I have read the release form and agree to the release of liability required to participate in the program.

Photo / Image Release

I grant the Franklin County Sheriff’s Office and County of Franklin the right to print, publish, broadcast and / or televise any and all photographic or video images of myself taken by the Franklin County Sheriff’s Office, or its designated agent, for use in commercial advertising, public service announcements, displays, publications and any other public relations efforts. I further release the Franklin County Sheriff’s Office and County of Franklin of any and all future claims and rights to these images.

Confirmation of Photo / Image Release *

I have read the photo/image release form and agree to the statement authorizing the use of my image.

Signature

I understand the importance of my commitment to attend all classes of the Sheriff’s Citizens Academy. I understand that the Franklin County Sheriff’s Office reserves the right to rescind my enrollment at any time during the course of the program.

Date / Time

Date

Time

Signature

Sheriff’s Citizens Academy Application

Notice to Applicants

Background Check Authorization

Release Form

Photo / Image Release

Signature