Citizen’s Sheriff Academy Form

"*" indicates required fields

Full Legal Name*

First Last M.I

Date Of Birth*

Social Security Number:

Current Address*

Street Address Apt. # City State

Telephone Number

Are you a student?

If Yes. Where?

Employer

Employer 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.

Signature

Date

Aggreement*

I understand that checking this box constitutes a legal signature confirming that I acknowledge and agree to the above terms of acceptance.

(859) 885-4139

Contact Us

Citizen’s Sheriff Academy Form

Please Read Carefully

Jessamine County Sheriff’s Office

201 N Main St, Nicholasville, KY, 40356, United States

Admin: (859) 885-4139

Fax: (859) 887-5317

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