Applicant Basic Details Full Name: * Date of Birth: * Current Address: * Previous Address: Telephone: * Email: * Driver's License Number: Driver's License State: - None -AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Marianas IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyoming Driver's License Expiration: Applicant Employment Details Current Employer: * Employer Phone: * Job Title: * Employment Location: * Previous Employer(s): Application Terms I hereby state that I am a willing volunteer wishing to participate in the Cedarburg Police Department’s Citizens’ Police Academy.I state that I understand that a portion of the Citizens’ Police Academy involves practical exercises. I further state that I understand that participation in these practical exercises is totally voluntary on my part, and if chosen to participate, I am doing so at my own risk.I understand and agree that as a participant in the Citizens’ Police Academy, I am not an employee of the Cedarburg Police Department nor the City of Cedarburg. I understand and agree that the Cedarburg Police Department, or its agents, may conduct a background check on me to ascertain any and all information of concern and to determine eligibility for entry into the Citizens’ Police Academy. I release the Cedarburg Police Department and its agents from all liability.I understand and agree that this application in no way obligates the Cedarburg Police Department to allow my entry into the Citizens’ Police Academy. I Agree to These Terms * Yes Leave this field blank
