Fillable Form 1.: Springfield Police Division Citizen Police Academy (City Of Springfield, Ohio)

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Form 1.: Springfield Police Division Citizen Police Academy (City Of Springfield, Ohio)

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The Form 1.: Springfield Police Division Citizen Police Academy (City Of Springfield, Ohio) form is 2 pages long and contains:

  • 0 signatures
  • 10 check-boxes
  • 28 other fields

Country of origin: US
File type: PDF

U.S.A. forms for City Of Springfield, Ohio

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Springfield Police Division
Citizen Police Academy Application
1.
Name _________________________________________________________________________
Last First Middle
Maiden
2.
Social Security Number _________
_
____
______________ Date of Birth __________________
3.
Home Address
____________________________________________________
Street
Apt.
___________________________________________________________________
City State Zip Code
4.
Mailing Address______________
___________________________________________________
(If different from home address)
5. Telephone
-
Home ________________Office________________ Message________________
6.
Driver
s License Number: ________________ St
ate:_____________
Expiration Date: ________________ Is this License currently valid? Yes____ No____
7.
Have you ever been convicted of a felony? Yes_______ No________
Have you ever been convicted of a misdemeanor
? Yes____No____
If the answer is Yes
explain when, where and the disposition of the case
_______________________________________________________________________________
_______________________________________________________________________________
____________________
___________________________________________________________
Please use the back of the application if additional space is necessary
8. Do you currently have any criminal or traffic charges pending in any jurisdiction? Yes___ No____
Please explain__________________________________________________________________
9.
Place of Employment_______________________________________________________
Address:
_______________________________________________________________________
Street City State Zip Code
Duties Performed_________________________________________________
10.
Why do you wish to attend the Citizen P
olice Academy?
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
___
____________________________________________________________________________
_______________________________________________________________________________
11.
Do you currently have a family member working for the Springfield Police Division? Yes__ No__
If Yes, please list the name of this family member _________________________________
(OVER)
I certify that all statements made on this application are true and complete. I hereby
authorize the Springfield Police Division to conduct a background investigation and to
make an examination of the listed information for
the purpose of evaluating my
application. I understand that any omission or false statement on this application may
disqualify me to attend the Citizen Police Academy.
Incomplete and/or unsigned applications will not be considered.
__________________________________
_________________
Signature
Date
E-
Mail address (if applicable)_____________________________________________
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Form 1.: Springfield Police Division Citizen Police Academy (City Of Springfield, Ohio)

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Completed 5 August 2020

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