Fillable Montgomery Police Department Citizen's Academy - Application (City of Montgomery)

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Montgomery Police Department Citizen's Academy - Application (City of Montgomery)

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Montgomery Police Department
Montgomery Police Department
Citizen's Academy - Application
Applicants must be 18 years of age or older to attend Academy. No prior felony convictions.
This application is due no later than 14 days prior to the first day of class in order to be considered. There are only
20 openings in each academy class; therefore, not every applicant will be accepted. An eligibility list will be
established for last minute cancellations. You will be notified the week prior to the start of class of the status of your
application.
Date of Application: ___________________________________________________________
Name: _______________________ _______________________ _____________________
Last First Middle
Maiden Name: _______________________________________________________________
Date of Birth: ______ / ______ / ______ Age: _______ S.S#: ______-____-________
Home Address: _______________________________________________________________
City: _________________________________________ State: __________ ZIP: __________
Mailing address if different: _____________________________________________________
City: _________________________________________ State: __________ ZIP: __________
E-Mail Address: ______________________________________ ☐H ☐C Phone: ___-___-____
Emergency Contact: _____________________ Relation: ____________ Phone: ___-___-____
Address: _____________________________________________________________________
Place of Employment: ___________________ Occupation: ____________ Phone: ___-___-____
List all memberships in community groups, civic organizations, etc:
______________________________________________________________________________
______________________________________________________________________________
_____________________________________________________________________________
What is your objective in enrolling in the Citizen’s Academy and why should you be considered?
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Montgomery Police Department
Citizen's Academy - Application
Please answer YES or NO to the following questions and provide explanations where needed.
1) Do you have a valid driver’s license? ☐YES ☐NO
2) Are you 18 years of age or older? ☐YES ☐NO
3) Do you have any special needs that require accommodations in order for you to participate
in the program? ☐YES ☐NO
If YES, please explain:
4) How did you hear about the citizen academy?
5) Do you know someone who has already completed a citizen’s police academy before?
☐YES ☐NO If YES, who?
6) Have you ever applied for the academy before? ☐YES ☐NO
If YES, please explain:
7) Have you ever been through another citizen’s academy before? ☐YES ☐NO
If YES, Where:
8) Are you interested in law enforcement as a career? ☐YES ☐NO
9) I understand this program is not the regular police academy but a program to familiarize me
with my local Police Department and staff, and will not certify me as a Law Enforcement
Officer. ☐
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Please note: This application must be completed fully and signed. Any missing information will disqualify the
applicant from consideration.
Email the completed application to police@ci.montgomery.tx.us or bring to:
101 Old Plantersville Rd.
Montgomery, TX 77356
Montgomery Police Department
Citizen's Academy - Application
If you are accepted as a student, you will receive instruction and educational materials related to the law
enforcement mission of the Montgomery Police Department. As the material presented will be of a privileged or
confidential nature and due to the sensitivity of the information, it is necessary for the Montgomery Police
Department to conduct a background check to determine suitability of those persons desiring to attend the
academy classes. Please answer the following questions as accurately and completely as possible. Any intentional
misrepresentation or omission of facts will be grounds for denial of admission to the academy, or if already enrolled,
immediate termination. A criminal history check will be made on all persons making application for enrollment.
Class A and Class B Misdemeanor convictions will be accepted only on a case by case basis. No violent criminal
offenses or felony convictions will be accepted.
Driver’s License Number: State:
Do you go by any other names or aliases now or have you in the past? ☐Yes ☐No
If yes- Explain: (Do not include maiden name unless used in the last 5 years.)
Are you a member of, or ever been affiliated with a law enforcement agency? ☐Yes ☐No
If yes- Explain:
Have you ever lived outside of the U.S. (or its territories) in excess of 90 days? ☐Yes ☐No
If yes- Explain:
Have you ever been convicted of a Class B, Class A or Any Felony Offense, or are you currently on
probation for any offense? ☐Yes ☐No
If yes- Explain:
APPLICANT MUST COMPLETE THE FOLLOWING:
I, hereby acknowledge that I have completed the above application completely
and accurately to the best of my knowledge. I also acknowledge that the Montgomery Police Department will
be conducting a background investigation on me to determine my suitability for admission to this program.
Permission is hereby granted to perform a background investigation based on the information given in this
application.
Signature of Applicant: Date:
☐ By clicking this box, I acknowledge the above statement and choose to electronically submit my application.
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Montgomery Police Department
Citizen’s Academy - Application
POLICE RIDE-ALONG RELEASE OF LIABILITY
WHEREAS, the undersigned has requested the privilege of accompanying members of the Montgomery
Police Department in the carrying out of their official duties; and
WHEREAS, the undersigned is fully aware of the dangers and possible consequences of
accompanying police officers in the administration of their duties, including personal injury or death; and
WHEREAS, the Montgomery Police Department is committed to developing a community awareness of
functions and routine tasks of police officers in the course of their daily affairs:
NOW THEREFORE, in consideration of the privilege of being allowed to accompany various officers of the
Montgomery Police Department in the carrying out of their official duties, I, the undersigned, covenant and agree
with the City of Montgomery, the Montgomery Police Department, its police officers and all other officers,
employees and agents of the City of Montgomery, that I will never institute or prosecute any claim, suit or action at
law or otherwise against the City of Montgomery, nor its employees, nor will I institute, prosecute or in any way
aid in the institution or prosecution of any claim, demand, action or cause or action for damages, loss or injury
either to person or property, or both, which may arise or which I, my heirs, executors, administrators hereafter may
have for or by reason of my participation in an on-site observation of the activities of the Montgomery Police
Department. I further agree to indemnify and hold harmless all such parties against any claim or cause of
action arising out of or related to any of my actions or failure to take action committed in the course of
accompanying such officers.
THE UNDERSIGNED EXPRESSLY WAIVES ALL RIGHTS OF ACTION, CLAIMS AND
DEMANDS AGAINST ALL PERSONS WHOMSOEVER CONNECTED TO THE CITY OF
MONTGOMERY, TEXAS.
IN WITNESS WHEREOF, I have hereunto set my hand this the _______ day
of
________________________, 20______.
__________________________________ ___________________________________________
(Signature) (Printed Name of Applicant)
_______________________________________________________________________________
(Address of Applicant)
________________________________________
(Signature of Witness or Issuing Supervisor)
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Montgomery Police Department Citizen's Academy - Application (City of Montgomery)

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Completed 14 July 2020

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