Citizen’s Academy Application Form Last Name: First Name: Middle: Street Address: City: State: Date of Birth: Social Security Number: Telephone # (Day) (Evening) Occupation: Employer: Length of Employment: Months Personal reference that we may contact: Name Address: Phone: Have you ever been arrested, if so what for? Have you ever been convicted of a felony criminal offense; and if so, what was the offense? What is your reason for wanting to participate in the Citizen’s Police Academy? All applicants must be at least 21 years of age. A background check will be done on each applicant. The Duchesne County Sheriff’s Office reserves the right to deny entry to the Academy based on the findings of a background check. All information on the above application is true. I authorize the Duchesne County Sheriff’s Office to conduct a background check based on this application. Signature: Date: Return by Fax or Email to: Attn: Lt. Jeremy Curry PO Box 985 Duchesne, UT 84021 Fax (435)738-2637
Citizen’s Academy Application Form Last Name: First Name: Middle: Street Address: City: State: Date of Birth: Social Security Number: Telephone # (Day) (Evening) Occupation: Employer: Length of Employment: Months Personal reference that we may contact: Name Address: Phone: Have you ever been arrested, if so what for? Have you ever been convicted of a felony criminal offense; and if so, what was the offense? What is your reason for wanting to participate in the Citizen’s Police Academy? All applicants must be at least 21 years of age. A background check will be done on each applicant. The Duchesne County Sheriff’s Office reserves the right to deny entry to the Academy based on the findings of a background check. All information on the above application is true. I authorize the Duchesne County Sheriff’s Office to conduct a background check based on this application. Signature: Date: Return by Fax or Email to: Attn: Lt. Jeremy Curry PO Box 985 Duchesne, UT 84021 Fax (435)738-2637
Duchesne-Co-Sheriffs-Citizens-Academy-application.docx