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Citizens Police Academy Application
Name (*)
Address (*)
Email Adress (*)
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Date of Birth (*)
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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?
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No
If yes, please explain
EMPLOYMENT: List information on the last 2 jobs you have held (please state if retired, unemployed, Homemaker, etc.)
Present Employer (*)
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Address
Supervisor
Your Title
Hire Date
Previous Employer
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References (list 2) (*)
List two immediate family members/close friends that can be notified in the case of an emergency
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Relationship (*)
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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.
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