HomeMy WebLinkAbout11-13-2001 Communication
IOWA CITY POLICE DEPARTMENT
CORALVILLE POLICE DEPARTMENT
JOHNSON COUNTY SHERIFF°S DEPARTMENT
UNIVERSITY OF IOWA DEPARTMENT OF PUBLIC SAFETY
CITIZENS ACADEMY
APPLICATION FORM
Please type or pfint legibly in black ink.
NAME:
FIRST MIDDLE LAST
ADDRESS:
STREET APT. # C~TY
HOME PHONE: WORK PHONE:
DATE OF BIRTH: / / . SOC. SEC.ff
DRIVERS LIC.#
EMPLOYER: OCCUPATION:
EMPLOYER'S ADDRESS:
HAVE YOU BEEN ARRESTED FOR ANY OFFENSE OTHER THAN TRAFFIC?
YES ( ) NO ( )
IF YES, WHAT FOR? WHEN? WHERE?
ARE YOU ABLE TO ATTEND 8 OR MORE SESSIONS? YES (.) NO ( )
ON A SEPARATE SHEET, EXPLAIN WHY YOU WANT TO ATFEND THE CITIZENS
ACADEMY. Please type or pfint legibly in black ink.
PLEASE CIRCLE THE SIZE SHIRT THAT YOU WEAR: S M L XL XXL
I hereby certify that the information in this application is true and complete to the best of my
knowledge. You are hereby authorized to make any investigation of my personal history deemed
necessary of consideration to attend the Citizens Police Academy.
applicant's signature date
IOWA CITY POLICE DEPARTMENT
CORALVILLE POLICE DEPARTMENT
JOHNSON COUNTY SHERIFF'S DEPARTMENT
UNIVERSITY OF IOWA DEPARTMENT OF PUBLIC SAFETY
ACADEMY INSTRUCTIONS
1. The Citizens Police Academy shall not interfere with routine operations of any law
enforcement agency. ~.
2. During ride along activities, participants will follow all instructions given by the officer. No
interference with the performance of any officer shall be permitted.
3. The student shall not be armed at any time.
4. Participants who are asked to identify themselves should explain that they are a Citizens
Academy participant.
5. SMOKING IS NOT ALLOWED in any govemment building or government vehicle.
6. A cdminal records check will be conducted on all students pdor to the academy.
7. All participants will conduct themselves in an appropriate and professional manner.
8. Violation of any instruction, guideline, rule, or failure to comply with a reasonable request
will terminate the citizen's participation in the academy. This is at the discretion of any
member of the Coralville or Iowa City Police Departments, Johnson County Shedffs
Department, or University of Iowa Department of Public Safety.
In consideration of the above law enforcement agencies granting permission to enter in or upon
any promises or vehicles which are under their actual care or constructive or passive control, I
heroby waive all claims to .damage or loss to my person or property which may be caused by any
act, or failure to act, of the Coralville and/or Iowa City Police Departments, Johnson County
Shedff's Department, University of Iowa Department of Public Safety, its officers, agents or
employees. I assume the dsk or all dangerous conditions in, upon or about the promises or
vehicles and waive any and all notice or existence of such conditions.
- .! I certify that I understand the raquiroments and rosponsibilities of participants in this program.
applicant signature date