Citizens Police Academy Application

Name (*)

Address (*)

Email Adress (*)

Phone (*)

Date of Birth (*)

Driver's License Number (*)

Resident of? (*)

How Long? (*)

Explain briefly why you wish to be enrolled in the Lakes Area Citizens Police Academy

Please list any associations, clubs or organizations you belong to:

Have you ever been arrested for, convicted of, or cited for an offense other that traffic fines of $200 or more?

Yes

If yes, please explain

EMPLOYMENT: List information on the last 2 jobs you have held (please state if retired, unemployed, Homemaker, etc.)

Present Employer (*)

Phone

Address

Supervisor

Your Title

Hire Date

Previous Employer

Phone

Address

Supervisor

Your Title

Hire Date

References (list 2) (*)

List two immediate family members/close friends that can be notified in the case of an emergency

Name (*)

Relationship (*)

Address (*)

Phone (*)

Name (*)

Relationship (*)

Address (*)

Phone (*)

Please review your answers carefully and read the statement below before submitting this application.

I hereby certify that there are no willful misrepresentations, omissions or falsifications in the forgoing statements and answers to questions. I understand that any omission or false statements on this application shall be sufficient cause for rejection for enrollment or dismissal from the Lake Area Citizens Police Academy.

I further understand that the Novi, Walled Lake, Wixom, Wolverine Lake, and South Lyon Police Departments will be conducting a thorough background investigation that may include, but not be limited to, and criminal history, employment history and personal references. Novi Police reserve the right to perform a background check on all applicants and deny course admittance based on said results.

By submitting this application, I request that a member of the Novi, Wixom, Walled Lake, Wolverine Lake, or South Lyon Police Department contact me with any further questions, prior to this on-line application being approved.