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Citizens Police Academy Application

Name (*):

Address (*):

Email Adress (*):

Phone (*):

Date of Birth (*):

Driver's License Number (*):

Resident of? (*):

How Long? (*):

Explain briefly why you wish to be enrolled in the Lakes Area Citizens Police Academy

Why? (*):

Please list any associations, clubs or organizations you belong to:

Clubs:

Have you ever been arrested for, convicted of, or cited for an offense other that traffic fines of $200 or more?

History:

YesNo

If yes, please explain.:

EMPLOYMENT: List information on the last 2 jobs you have held (please state if retired, unemployed, Homemaker, etc.)

Present Employer (*):

Phone:

Address:

Supervisor:

Your Title:

Hire Date:

Previous Employer:

Phone:

Address:

Supervisor:

Your TItle:

Hire Date:

References (list 2) (*):

List two immediate family members/close friends that can be notified in the case of an emergency

Name (*):

Relationship (*):

Address (*):

Phone (*):

Name (*):

Relationship (*):

Address (*):

Phone (*):

Please review your answers carefully and read the statement below before submitting this application.

Answer the question below:

Is eight = eight ? (true/false)

"I hereby certify that there are no willful misrepresentations, omissions or falsifications in the forgoing statements and answers to questions. I understand that any omission or false statements on this application shall be sufficient cause for rejection for enrollment or dismissal from the Lake Area Citizens Police Academy."

Yes
No

"I further understand that the Novi, Walled Lake, Wixom, Wolverine Lake, and South Lyon Police Departments will be conducting a thorough background investigation that may include, but not be limited to, and criminal history, employment history and personal references. Novi Police reserve the right to perform a background check on all applicants and deny course admittance based on said results."

Yes
No

"By submitting this application, I request that a member of the Novi, Wixom, Walled Lake, Wolverine Lake, or South Lyon Police Department contact me with any further questions, prior to this on-line application being approved."

Yes
No

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