DEMOPOLIS CITIZEN’S PUBLIC SAFETY ACADEMY APPLICATION FORM

Thank you for your interest in the Demopolis Public Safety Citizen Academy. We request that you complete the application form in order to be considered for upcoming classes.  Due to the limited number of spaces, not everybody will be able to participate; therefore you will be notified if you are selected.  Several classes are offered each year and a waiting list will be established.

Because of the sensitive nature of police work, a brief background check will be conducted to ensure that you meet our eligibility requirements.  You must live or work within the police jurisdiction of the City of Demopolis, be 21 years of age, NO felony convictions anywhere, NO misdemeanor arrests in the past 5 years, and NO assault, domestic violence, or weapons convictions.

Thank you again for your interest in the Demopolis Police & Fire Departments and good luck!

Chief  Rex Flowers , Demopolis Police Department

Chief Talmus Williams, Demopolis Fire Department

 

Name required , First and Last are required.
 
 
Date of Birth required ,
 
Home Address required , Address Line 1, City, State and Zip Code are required.
 
 
Address Line 1, City, State and Zip Code are required.
 
 
Phone (home) required ,
 
 
Phone (work) required ,
 
 
Phone (cell) required ,
 
 
Occupation required ,
 
 
Occupation Address required , 
 
 
Driver's License or ID Card Number required , Driver's License or ID Card Number is required.
 
 
Driver's License or ID Card Number is required.
State required , State is required.
 
State is required.
List any convictions (other than minor traffic) required ,
 
 
Reason for participating required ,
 
 

APPLICANT QUESTIONAIRRE 

Have you ever been arrested for a felony or misdemeanor? required ,
YesNo
 
Please explain the charges and details. required ,
 
 
The Demopolis Citizens Public Safety Academy is a twelve-week program. We will meet each Tuesday Night from 5:30 pm until 8:30 pm. Are you able to meet this time commitment? required ,
YesNo
 

Students must be present for at least nine of the classes in order to graduate.

Why do you want to attend the Citizens Public Safety Academy and what do you hope to gain from attending? required ,
 
 
Have you ever had any contact with the Demopolis Police Department? If you have, list below if it was positive or negative. required ,
 
 
Do you own a business in the city of Demopolis? If so, then list below. required ,
 
 
If you are not selected for this session of the Citizens Public Safety Academy would you be willing to be put on a list to attend the next academy? required ,
YesNo
 

RELEASE OF LIABILITY, CERTIFICATION OF ACCURACY, AND DISCLAIMER

1.  RELEASE.  For and in consideration of being selected and being allowed to attend the Demopolis Citizen’s Public Safety Academy, I hereby release, hold harmless, and indemnify the City of Demopolis; the Demopolis Police Department and Fire Department; and all former, present, and future employees, officers, and agents of the City of Demopolis and/or Demopolis Police Department, Demopolis Fire Department from and against all civil liability that may directly or indirectly arise out of my attendance, participation, and/or graduation in or from said Citizen’s Police Academy. This release shall be binding on my estate, heirs, executors, administrators, representatives, successors, and assigns.

2.  CERTIFICATION OF ACCURACY.  I certify that all information on the application form or as otherwise provided to the City of Demopolis Police Department and Demopolis Fire Department in relationship to the Citizen’s Public Safety Academy, is accurate and true to the best of my knowledge, I understand that I may be excelled and disqualified from the Citizen’s Police Academy if any information I have provided is untrue or inaccurate.

3.  DISCLAIMER.  I understand that the Citizen’s Public Safety Academy is a multi-faceted educational program designed to provide members of the community such as me with the opportunity to gain specific knowledge about the philosophy and processes of the Demopolis Police Department and Demopolis Fire Department. I understand that participation in or graduation from the Citizen’s Public Safety Academy will not qualify or allow me to engage in law enforcement activity including without limitation activity related to detaining or arresting others, issuing citations, searches and seizures, driving in disregard of the rules of the road, or use of force. I understand that participation in or graduation from the Citizen’s Public Safety Academy will not qualify me to own, use, or possess firearms or other weapons.

Signature required , Signature is required.
 
Signature is required.
Date required , Date is required.
 
 
Date is required.
 
 
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