Fillable MIAMI GARDENS POLICE DEPARTMENT CITIZENS POLICE ACADEMY APPLICATION (City of Miami Gardens)

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MIAMI GARDENS POLICE DEPARTMENT CITIZENS POLICE ACADEMY APPLICATION (City of Miami Gardens)

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MIAMI GARDENS POLICE DEPARTMENT
CITIZENS POLICE ACADEMY
APPLICATION
Thank you for your interest in the Miami Gardens Citizens Police Academy. Through your participation,
you will receive a thorough understanding of the inner workings of a modern police department, the duties
of a police officer, the functions of various divisions within the department, and how our agency interacts
with other first responders. Your instructors will be active-duty law enforcement officers and other public
safety officials. Participation in the Citizens Police Academy is voluntary and there is no cost or tuition.
However, we ask that you commit to attending the entire 10-week program. Upon your successful
completion, you will receive a certificate attesting to your participation.
Please complete this application in its entirety. Please print legibly.
PERSONAL
Name: ______________________________________________________________
Last First Middle Maiden (if applicable)
Address: ___________________________________________________________
Street Apt. Number City State
E-Mail Address: _____________________________________________________
Home Phone: ________________ Cell Phone: ______________________
Driver License: State: __________ Number: _______________________
Date of Birth: _________________
BACKGROUND
Please briefly explain why you want to enroll in the Miami Gardens Police Department’s Citizens
Police Academy:
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
Please list any associations, clubs or organizations you belong to or are affiliated:
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
For Citizens Police Academy use only:
Received by___________________________ Date: __________________ Time: ____________
EMERGENCY CONTACTS
List two immediate family members or close friends that can be contacted in the event of an
emergency:
Name: __________________________________ Relationship: _____________
Address: ________________________________ Phone: __________________
Name: __________________________________ Relationship: _____________
Address: ________________________________ Phone: __________________
CRIMINAL HISTORY
Have you ever been convicted of a felony? ( ) Yes ( ) No
If “Yes,” please explain: ________________________________________________________
___________________________________________________________________________
Have you had any previous experience with law enforcement? ( ) Yes ( ) No
If “Yes,” please explain, including date(s) and incident(s): ______________________________
____________________________________________________________________________
____________________________________________________________________________
REFERRALS
Were you referred to the Citizens Police Academy? ( ) Yes ( ) No
If “Yes,” by whom were you referred? ______________________________________________
SPECIAL NEEDS
Do you have special needs that must be accommodated in order for you to participate in the
Citizens Police Academy: ( ) Yes ( ) No
If “Yes,” please describe: ________________________________________________________
____________________________________________________________________________
Please review your statements carefully and read the statement below before signing this
application:
I hereby certify that there are no willful misrepresentations, omissions or falsifications in the
foregoing statements and answers to the questions in the document. I understand that any such
omissions or false statement on this application shall be sufficient cause for rejection of
enrollment or dismissal from the Miami Gardens Citizens Police Academy. I further understand
the Miami Gardens Police Department will conduct a thorough background investigation that
may include, but not limited to, any criminal history, employment history and personal
references.
_____________________________ _________________________
Signature Date
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MIAMI GARDENS POLICE DEPARTMENT CITIZENS POLICE ACADEMY APPLICATION (City of Miami Gardens)

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Completed 4 August 2020

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