Linn County Sheriff's Office - Fall 2015 Citizen Academy Application

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This form is the application, including hold harmless agreement, for participants interested in the Citizens Academy with the Linn County Sheriff's Office

Release, Indemnification and Hold Harmless Agreement for Linn County Sheriff's Office Citizen's Academy *

The undersigned, in consideration for the privilege of being a participant in the Linn County Sheriff’s Office’s Citizen’s Academy and recognizing that such activity involves certain inherent risks and dangers, does hereby agree to assume the risks attendant to all activities associated with participation in the Citizen’s Academy of the Linn County Sheriff’s Office. The undersigned for him/herself, legal representatives, heirs and assigns does hereby release, waive and discharge the Linn County Sheriff’s Office, its deputies, agents and employees from any liability for any loss or damage or any claim or damages resulting from my participation in the Citizen’s Police Academy of the Linn County Sheriff’s Office on account of any injury to my person or property, whether caused by negligence of the Linn County Sheriff’s Office, its deputies, agents and employees, or otherwise, while I am participating in the Citizen’s Police Academy of the Linn County Sheriff’s Office. The undersigned hereby agrees to indemnify, defend and hold harmless the Linn County Sheriff’s Office, its deputies, agents and employees from any and all claims, losses, damages, causes of action and liability, including all expenses of litigation for injury to myself or any person or loss of property arising out of my participation in the Citizen’s Police Academy of the Linn County Sheriff’s Office.

I agree to the above terms

I do not agree to the above

Required

NAME *

Please provide us your full legal name.

Other names you have used

Please provide a list of all aliases or prior names you have used.

ADDRESS *

Please provide your current physical residence address.

Date of Birth *

For participation to be granted, we will need your date of birth.

YYYY

Social Security Number *

This information will be used for screening and computerized background purposes.

Driver's License Number *

Best contact phone number *

Please provide a number where it is best to contact you.

Email address *

A large majority of communication, planning, and last-minute changes will be done via email. Please provide an email you check regularly.

Are you currently: *

Please tell us who you are currently working for, or where you were previously employed.

Please briefly list or describe any civic activities/organizations you are involved with. *

Have you ever been arrested for any criminal offense? *

If you answered yes to the previous question, please tell us the circumstances of the arrest.

Please tell us when and where you were arrested, and by what agency.

What experiences in your past have you had with law enforcement? *

Please answer this question, "I would characterize my previous contacts with law enforcement to be..." *

Tell us more about why you want to be apart of the Citizen's Academy

Briefly explain your interest in the Citizen's Academy *

What do you expect to gain from attending the Citizen's Academy? *

Would you like to be considered for a position as a Sheriff's Office Volunteer? *

Yes

Required

If yes, what skills, knowledge, and experiences do you have to offer and what are your preferences?

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