Citizens Police Academy Application
Name_____________________________________ Date of Birth_________________
Telephone (H) ________________ (W) _______________ (C) ___________________
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