HomeMy WebLinkAboutCitizenAcademyApplication
OSHKOSH POLICE DEPARTMENT
Citizen’s Police Academy
(Application)
1. Name: ______________________________________________________________________
Last First Middle
2. Date of Birth: ___________________
3. Address: ____________________________________________________________________
Street Apt # City State Zip Code
4. Email Address: _______________________________________________________________
5. Phone Number: Home: _________________________ Work: ________________________
Emergency Contact: _______________________________________________________
Name/Relationship/Phone Number
6. Have you ever been arrested for anything other than a traffic offense? Yes ______ No ______
If you answered yes, please explain:
______________________________________________________________________________
7. Place of employment: _________________________________________________________
Business Name Address City, State, Zip
Occupation: ____________________________________________________________________
8. Polo Shirt Size: Small _______ Med _______ Lg. ________ XL _________ XXL ___________
I certify that all information on this application is true and complete. I authorize any and all individuals,
company, organization or institution to release any and all information concerning statements made by me
on this application; and do hereby release all parties and individuals contacted from all liabilities for any
damages whatsoever incurred in providing such information. I also agree and understand that any
deliberate false statement or omission of facts to be completed on this application may disqualify me from
attending the Oshkosh Police Department Citizen Academy. My signature below acknowledges my
understanding and agreement with the information provided.
_____________________________________________________________ _______________________
Signature Date
Approved: _______________ Disapproved: _______________ Date/Time: _______________________