Citizens’ Academy Application Citizens' Academy Application Public application form for the Sheriff's Citizens' Academy. Step 1 of 5 20% Last:*First:*Middle:*Middle Name:List all other names you have used, including nicknames and maiden names. If you have ever used any legally changed name, please list the time period this occurred and the circumstances.Residence Address:*City:*State:*--------------------------TennesseeAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces PacificZip Code:*Phone:*Best phone number to contact you:Date of Birth:*mm/dd/yyyyDriver's License State Issued:SexMaleFemalePrefer not to answerChoose OneEmail* Enter Email Confirm Email Email address where you can be reached: jdoe@email.com EthnicityHispanic or Latin: a person of Cuban, Mexican, Chicano, Puerto Rican, South or Central American, or origin, regardless or race.White: a person having origins in any of the original peoples of Europe, the Middle East, or North Africa.Black or African American: a person having origins in any of the black racial groups of Africa.Asian: a person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian subcontinent including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and VietnamNative Hawaiian or Other Pacific Islander: a person having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands.American Indian or Alaska Native: a person having origins in any of the original peoples of North and South America (including Central America), and who maintains tribal affiliation or community attachment.Two or More Races: a person who primarily identifies with two or more of the above race/ethnicity categories.Submission of this section is voluntary: Employer:Employer Address:City:State:--------------------------TennesseeAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces PacificZip Code:Company Website:ex. www.website.comJob Title: List any organizations, association, or community groups to which you belong:List prior citizen's academies and dates of graduation:Please let us know why you are interested in attending the Sheriff's Citizen's Academy:*Please tell us where you heard about the Sheriff's Citizen's Academy:*ex. word of mouth, friend/family member, website, radio advertising.Our citizens' academy will involve meeting at several different locations around Nashville having classroom settings and tours that will require walking. Please let us know of any accommodations that would need to be made for you to participate, including dietary restrictions. This will not preclude you from being eligible to participate. Any request for accommodations must be made in advance.*Do you have any relatives and/or close associates who are incarcerated with the Davidson County Sheriff's Office or with the former Metro Detention Center? (This will not preclude you from being considered for participation)* Yes No If "Yes", list the person's name(s) and your association with each person:Incarcerated person's name:Last, First, MIRelationship:ex. Brother, Wife, Neighbor, Childhood FriendHousing Location (if known):ex. CDM, DDC, MCCAt the time of this application, are you UNDER 21 years of age?* Yes No (must answer to continue)Have you ever been arrested or convicted of any criminal offense?* Yes No If you answered "yes" to the above question about convictions, please explain: Consent* As an applicant for the Davidson County Sheriff's Office Citizens' Academy, I hereby authorize the Davidson County Sheriff's Office (DCSO) to conduct a criminal history background investigation, including convictions, pending charges, and outstanding warrants. I understand that this criminal history check is being conducted due to the nature of the classes given at the Citizens' Academy.As an applicant for the Davidson County Sheriff's Office Citizens' Academy, I hereby authorize the Davidson County Sheriff's Office (DCSO) to conduct a criminal history background investigation, including convictions, pending charges, and outstanding warrants. I understand that this criminal history check is being conducted due to the nature of the classes given at the Citizens' Academy.Consent* I understand that all available police and criminal records will be checked and that the information will be used in determining eligibility of applicants for the Citizens' Academy. All information is to remain confidential as required by state and federal statutes.I understand that all available police and criminal records will be checked and that the information will be used in determining eligibility of applicants for the Citizens' Academy. All information is to remain confidential as required by state and federal statutes.Consent* I understand the DCSO Citizens' Academy is NOT a DCSO training program for certification as a correctional officer.I understand the DCSO Citizens' Academy is NOT a DCSO training program for certification as a correctional officer.Consent* I certify that all statements made on this application are true and complete. I authorize the Davidson County Sheriff's Office to examine this information to evaluate my participation in the Sheriff's Citizen's Academy.I certify that all statements made on this application are true and complete. I authorize the Davidson County Sheriff's Office to examine this information to evaluate my participation in the Sheriff's Citizen's Academy.UntitledFirst ChoiceSecond ChoiceThird Choice