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APPLICANT INFORMATION

Bluffton Police Department Citizen Police Academy
Name*
Date*
Address*
City*
State*
Zip Code*
Phone Number*
Email Address*
Date of Birth*
Social Security #*
Is your driver's license issued by South Carolina?*
1. Yes
2. No
Driver's License #*
If not issued by South Carolina, what state?
Gender*
Race*
Emergency Contact Name*
Emergency Contact Phone*
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EDUCATION HISTORY

Highschool
Address
Dates
Dates Start Date
—
Dates End Date
Did you graduate?
1. Yes
2. No
College
Address
Dates
Dates Start Date
—
Dates End Date
Did you graduate?
1. Yes
2. No
If yes, what's your degree?
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EMPLOYMENT HISTORY

Employer Name
Phone
Address
City
State
Zip Code
Job Title
Supervisor
Dates
Dates Start Date
—
Dates End Date
May we contact for reference?
1. Yes
2. No
Employer Name
Phone
Address
City
State
Zip Code
Job Title
Supervisor
Dates
Dates Start Date
—
Dates End Date
May we contact for reference?
1. Yes
2. No
Employer Name
Phone
Address
City
State
Zip Code
Job Title
Supervisor
Dates
Dates Start Date
—
Dates End Date
May we contact for reference?
1. Yes
2. No
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MILITARY SERVICE

Branch
Dates
Dates Start Date
—
Dates End Date
Rank at Discharge
Type of Discharge
If other than honorable, please explain
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Driving Record & Criminal History

Has your license ever been suspended or revoked?*
1. Yes
2. No
If yes, please provide details such as date, reason and length of suspension
Have you ever been convicted of a crime other than minor traffic offenses?*
1. Yes
2. No
If yes, please provide information, such as date of arrest, charge and disposition of case
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Questionnaire

What experience have you had with law enforcement?*
What is the extent of your community involvement?*
Why do you desire to participate in this program?*
How do you think the community and police department may benefit from your participation in the program? *
What do you expect to learn from this experience?*
Have you ever applied for the academy before? If so, when?*
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COMMITMENT TO ATTENDANCE

The Bluffton Police Department Citizen Police Academy is a 8-week which meets Monday evenings from 6 p.m. to 8:30 p.m. Attendance is the most important factor in reaching the desired goal of the program. Two absences are permitted; however, full attendance is encouraged.
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SIGNATURE OF ACKNOWLEDGEMENT

The Town of Bluffton is an Equal Opportunity Employer and applies those same principles to selection of participants in the Citizens Police Academy. Selection is done without regard to race, religion, color, national origin, sex, age, political affiliation or disability.
ADA NOTICE: The Town of Bluffton will not discriminate against qualified individuals on the basis of disability in its services, programs or activities. The Town will make all reasonable modifications to policies and programs to ensure that people with disabilities have an equal opportunity to enjoy its programs, services and activities. Call 843-706-4550 for more information.
I certify that all statements made on this application are true and complete. I understand that I may be rejecting for submitting incomplete or false information. I hereby authorize employees of the Bluffton Police Department to make an examination of the above information for the purpose of evaluating my application.
By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.**
1. I agree. Electronic Signature
First Name*
Last Name*
Dates*
Dates
IMPORTANT: The training is not designed to certify citizens to perform law enforcement services. Its purpose is to enhance community relations and to provide citizens with insight into the criminal justice system. Class size is limited. Residents and citizens who live and/or work within the Town limits of Bluffton are given first priority.

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Citizens Police Academy

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APPLICANT INFORMATION

EDUCATION HISTORY

EMPLOYMENT HISTORY

MILITARY SERVICE

Driving Record & Criminal History

Questionnaire

COMMITMENT TO ATTENDANCE

SIGNATURE OF ACKNOWLEDGEMENT

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