Oakwood Citizens’ Police Academy Application Form

Name:
Mr. Miss. Mrs.
First
Middle Initial
Last
DOB:
Street Address:
City/State:
Zip
Home Phone:
Work Phone:
Cell Phone:
Are you an Oakwood resident?
Yes No
If yes, how long?
Email:
Are you an Oakwood employee?
Yes No
If yes, how long?
Business Name:
Business Address:
Education
High School Attended:
Date Graduated
College Attended:
Degree/Major:
Personal Training/Education:
Have you ever attended any other Citizens’ Police Academy?
Yes No
If yes, where?
Have you ever been denied admittance to any Citizens’ Police Academy?
Yes No
Background
Please explain why you wish to enroll in the Oakwood Police Department’s Citizens’ Police Academy:
Have you ever been arrested for, convicted of, or cited for any offense (other than a traffic fine) of $200 or less? Yes No
If you answered yes, on a separate sheet of paper, please explain your arrest in detail, listing appropriate dates, charges, locations and actions taken by the court system.
Employment
Present Employer:
Address:
Supervisor:
Title:
Phone:
Date Hired:
Previous Employer:
Address:
Supervisor:
Title:
Phone:
Date Hired:
References
Personal Reference No. 1:
Relationship:
Address:
Phone:
Personal Reference No. 2:
Relationship:
Address:
Phone:
Emergency Contact
Emergency Contact:
Relationship:
Phone:
List any known medical conditions and medications:
All information contained above is correct to the best of my knowledge.
Sign Signature:
Date: