Citizen’s Sheriff Academy Form "*" indicates required fields Full Legal Name* First Last M.I Date Of Birth* MM slash DD slash YYYY Email Social Security Number:Current Address* Street Address Apt. # City State Telephone NumberAre you a student?YesNoIf Yes. Where?EmployerEmployer Address Street Address City State Please Read Carefully Your signature on this form indicates that you are granting permission for the Jessamine County Sheriff's Office to conduct a criminal history check on you, prior to your participation in the Citizen's Sheriff Academy. It is further agreed that, should this criminal history check reveal any convictions of a criminal nature or high traffic offense, the Jessamine County Sheriff's Office may, at their discretion, disallow your participation in this program. If you have any special needs due to a physical disability, please notify the Sheriff's Office at 859-885-9512, so that we may make the appropriate accommodation.SignatureDate MM slash DD slash YYYY Aggreement* I understand that checking this box constitutes a legal signature confirming that I acknowledge and agree to the above terms of acceptance.
