Citizens Police Academy Application

Full Name

Street Address (Include City, State and Zip)

Phone Number - Mobile

Phone Number - Home

Date of Birth

mm/dd/yyyy

Race

Sex

Social Security Number

Employer

Occupation

Highest Education Level

Emergency Contact

Include name, relationship and phone number

Reference 1

Include name, phone number or email address

Reference 2

Include name, phone number or email address

Reference 3

Include name, phone number or email address

How did you hear about Citizens Police Academy?

Are you a member of a neighborhood group or assoc?

Authorization

Participation in the Citizens Police Academy classes may be photographed, filmed or names used in promotional activities of the Savannah Police Department. Confirm below that you give SPD permission to use these without compensation.

Have you ever been convicted of a crime?

Consent for a Background Check

Due to the information that will be presented at the Citizens Police Academy being of a sensitive nature to law enforcement, we must ensure confidentiality by requiring all applicants to submit to a Criminal History Check.

By agreeing, you authorize the director of the Citizens Police Academy to receive any criminal history record information pertaining to the individual identified in this form, which may be in the files of any state or criminal justice agency in the State of Georgia.

Do you consent?

Signature

By typing your name on the below line, you consent that you have completed this form and are submitting your electronic signature to apply for the Citizens Police Academy.

Send me a copy of my responses

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