Forms • Citizen&#39s Academy Online Application

Citizen's Academy Online Application

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Apply for an upcoming Citizens Academy Course

PERSONAL INFORMATION

First Name *

Last Name *

Date of Birth*

CONTACT INFORMATION

Street Address*

City*

State*

Phone Number*

Email Address*

Driver's License State

Driver's License Number*

Current Employer*

T Shirt Size *

Have you ever been convicted of a felony?*

Are you prohibited from owning/ possessing/ purchasing a firearm per federal law and/or Wyoming state law? *

Are you a subject of a domestic protection order?*

Have you ever been convicted in any court of a misdemeanor crime of domestic violence?*

Have you been arrested for any misdemeanor, including DWUI, within the last 3 years?*

Is it okay to contact you for additional information?

In consideration of the Agency, Douglas Police Department, processing my application, hereby irrevocably consent to the following:
1. I understand that a thorough and complete background investigation will be conducted for attendance of the CPA.
2. I understand that a background investigation is conducted by gathering and recording information about my past conduct and associations from any and all sources that the Agency, in its sole discretion, may deem appropriate, including: criminal or other Governmental files and records, past and present employers, and any other source of information available.
3. I hereby release from liability and agree to hold harmless; under any and all possible causes of legal action, including negligence, the City of Douglas, Converse County, the Douglas Police Department, the Agency and any of its officers, agents or employees for any negligent or wrongful statements, acts, omissions made or recorded in the course of my background investigation.
4. I hereby release from liability and agree to hold harmless under any possible cause of legal action, including negligence, any person or entity which furnishes information or opinions to the Agency as a part of my background investigation.
5. I authorize any person or entity contacted by the Agency during the course of my background investigation to furnish any information or opinions such person or entity may have regarding myself, my conduct or associations, regardless of any statutory or other privilege I may have.
6. I understand the need for confidentiality of sources and information in my background investigation, and I expressly agree that I will never attempt to obtain access to any part of the background investigation designated as confidential by the Agency. This release applies to any cause of action of any nature that might accrue to me.**

I fully understand that any intentional attempt on my part to provide INCORRECT or MISLEADING information would be just cause for rejection of my application*

* indicates required fields.

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