Class #21
May. 13th, 2014 - Jul. 29th, 2014
Enrollment Application


 FULL LEGAL NAME AND CONTACT INFORMATION
 
 
FIRSTNAME *
MIDDLE
LASTNAME *
 
 
ADDRESS *
   CITY
   
   STATE
   
   ZIP *
   
 
HOME PHONE
WORK PHONE
CELL PHONE
 
 
E-MAIL *
 

 ADDITIONAL INFORMATION
 
 
DOB *
MM/DD/YYYY
   SEX *
   
   RACE
   
 
 
DRIVER LICENSE # *
   STATE *
   
   EXPIRATION DATE *
    MM/DD/YYYY
 
 
SSN *
   OCCUPATION
   
 
LIST ALL STATES OF PAST RESIDENCE
   HOW DID YOU HEAR ABOUT THE CITIZENS' ACADEMY?
   
 
HAVE YOU EVER BEEN CONVICTED OF A FELONY? *    
 
STANDARDS OF ADMISSION:
  • Must be 21 years of age.
  • Must live or work in Shelby County, TN.
  • Applicants must complete an Enrollment Form, and a background investigation prior to being accepted.
  • Must not have any felony convictions.
  • Class size will be limited to thirty (30).

RELEASE & WAIVER:

As an applicant for the Shelby County Sheriff's Office Citizens' Academy, I am aware of the necessity and I authorize the Sheriff's Department to conduct a full inquiry into my Crinimal History background as to determine my suitability to attend the Citizens' Academy. I understand that any felony conviction will disqualify me from the Citizens' Academy. I hereby release the Shelby County Sheriff's Office, Shelby County, TN, their agents, employees, from any liability or damage which may result from obtaining any and all personal information gathered about me through my voluntary participation in this program. I understand my participation in all portions of the Citizens' Academy program is voluntary. I agree to assume and indemnify the Shelby County Sheriff's Office and Shelby County from any and all injuries or damages of any type that I may incur by participation in this program. I also understand and agree I am a volunteer. I certify that all statements in this form are true, correct and complete to the best of my knowledge. I understand all statements are subject to verification.

Upon submittal and acceptance of this form, you will receive an email confirmation form that you must print, sign and either mail or fax to:

Training Academy
Attn: Andrea Richardson
993 Dovecrest
Memphis, TN 38134
Fax: 901-222-6111