September 24, 2021

Citizens Police Academy Application

Posted

Name_____________________________________ Date of Birth_________________

Address____________________________________ City________________________

Telephone (H) ________________ (W) _______________ (C) ___________________

E-mail: _________________________________________________________________

Have you ever been convicted of a crime? _____YES _____NO

What for? _______________________________________________________________

When? ___________ Where? ____________________ Disposition__________________

Briefly explain your interest in the East Providence Citizens Police Academy

_______________________________________________________________________

Has your experience with law enforcement been good or bad? Briefly explain.

________________________________________________________________________

______________________________________________________________________________

Liability waiver: I hereby certify that the information contained in this application is true and complete to the best of my knowledge. I understand by virtue of my participation in this class that I may see or hear things of a confidential nature and, for this reason, I hereby authorize the police department to conduct a criminal record check if deemed necessary. As consideration for allowing me to participate in the Citizens Police Academy, I hereby waive claim whatsoever, my heirs and assigns, against the City of East Providence and the East Providence Police Department which may accrue as a result of my voluntary participation in the program.

Signature _______________________________ Date ____________________

Kindly return applications to:

Community Policing Sergeant Mark Norton

East Providence Police Department

750 Waterman Avenue

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