Application for Citizens Police Academy Applicant Profile Information:First Name: *Last Name: *Street Address: *Apartment, suite, etc:City: *State: *ZIP Code:Email Address: *Phone: *Employment Status:CheckboxFull -TimePart-TimeRetiredUnemployedIf Applicable, Current Employer0 / 25Street Address:Apartment, suite, etc:City:State:ZIP Code:Employment Dates:Employment Date:Business Phone Number:Personal Interest/ Knowledge:Do you have any civic or group affiliations?YesNoIf Yes, please explain:0 / 50Have you ever had any involvement with the Brockton Police Department or any other Police Department?YesNoIf Yes, please explain:0 / 50Please Explain why you are interested in attending the Citizens Police Academy and what do you hope to gain from it?0 / 100Please provide any additional information that you think would make you a good candidate for this program.0 / 100Emergency Contact Information:First Name: *Last Name: *Street Address:Apartment, suite, etc:City:State:Phone: *Citizens Police Academy Commitment Agreement:The Citizens Police Academy meets every Wednesday at the Brockton Police Department from 6:00 PM - 8:00 PM for 8 weeks, which includes the Academy Graduation. However, two of the classes within the 8 weeks, will meet from 6:00 PM - 9:00 PM, and one of those classes will meet at the Randolph Police Academy. We understand that with life unforeseen circumstances arise. Therefore, no more than 2 classes can be missed. Would you be able to commit to attending these classes?Would you be able to commit to attending these classes?YesNoIf you answered "No", please explain:0 / 50Citizens Police Academy T-shirt Size Preference (Please select one of the following options):SmallMediumLargeX-LargeXX-LargeImportant Details: Incomplete applications will not be processed. Application must give consent to a Criminal Background Check for consideration in the program. Applicants accepted into the Academy MUST sign a Liability Waiver to participate. Applicants will be notified by email of the status of their application, and all further correspondence is via email only. Applying for the Police Citizens Academy DOES NOT guarantee your seat. Applicants must be in good physical condition to participate in the MILO Simulation Training. Acceptance into this program will be on an individual basis as determined by the Chief of Police. If your application is approved, please understand that all Citizen Academy parking will be at the BAT Bus parking garage, across the street from the Police station. Light refreshments/ snacks will be served weekly. If you have food allergies, please provide details below. Academy personnel will do their best to accommodate any applicant's food allergies they are made aware of. Food Allergies:Authorization for Criminal Background Check:Click here to read the Authorization for Criminal Background Check, then return to the page to continue the application.By checking the "I agree" box below, you agree and acknowledge that you have read the authorization for Criminal Background Check document attached to this application in its entirety and agree to these terms. *I agreeCriminal Background Check Signature *Start signing your signature hereYour browser does not support e-Signature field.Criminal Background Check SignatureDisqualifiers:Click here to read the list of all disqualifiers to participate in this program, then return to the page to continue the application.By checking the "I agree" box below, you agree and acknowledge that you have read the Disqualifiers document attached to this application in its entirety and agree to these terms. *I agreeDisqualifiers Page Signature: *Start signing your signature hereYour browser does not support e-Signature field.Disqualifiers SignatureLiability Waiver:Click here to read the list of the Liability Waver to participating in this program, then return to the page to continue the application.By checking the "I agree" box below, you agree and acknowledge that you have read the Liability Waiver document attached to this application in its entirety and agree to these terms. *I agreeLiability Waiver Signature Agreement: *Start signing your signature hereYour browser does not support e-Signature field.Liability Waiver Signature AgreementMedia Release:I give permission for my photo/ image to be used as part of any slide show and/ or as part of any radio, television, or internet educational presentation/ advertisement/ video/ post; or on any social media platforms. I will not take or post any photos/ videos while in the academy without permission from the Chief of Police or her Designee.By checking the "I agree" box below, you agree and acknowledge that you have read the Media Release Agreement above in its entirety and agree to these terms. *I agreeMedia Release Signature: *Start signing your signature hereYour browser does not support e-Signature field.Media Release SignatureOnline Electronic Signature Agreement:By both checking the "I agree" box and signing this application, I understand that any omitted or false answers will be grounds for my application being rejected. I affirm that all my answers are complete and true and accurate to the best of my knowledge. I understand that participation in this program is voluntary and that the Brockton Police Department will make the final determination on the applicants to this program. *I agreeTotal Application Signature: *Start signing your signature hereYour browser does not support e-Signature field.Online Electronic Signature AgreementDate *Submit ApplicationPlease do not fill in this field.
