City of Springfield, Illinois

James O. Langfelder - Mayor

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Citizen Police Academy Application

The City of Springfield and the Springfield Police Department are currently accepting applications for its 2017 Citizens Police Academy. This program is an effort to enhance the community policing concept and increase public awareness. Please complete the application below to be considered for this year’s academy, required fields are denoted with a * symbol. Questions about the program may be directed to 217.788.8360.


CPA Application

Name of Applicant

First Name*
Middle Name*
Last Name*
Maiden Name
Other

Address

Street Address*
City*
State*
Zip Code*

Identification

Social Sec. #*
Driver's License # or Illinois ID Card #*

Personal Information

Date of Birth*
Sex
Race

Contact Information

Home Phone*
Work Phone
Email Address

Criminal History

Have you ever been arrested for a crime other than a traffic offense?*

If Yes, Please Explain

Have you ever been CONVICTED of a crime other than a traffic offense?*

If Yes, Please Explain

Emergency Contact

Full Name*
Phone*

Additional Information

What do you expect to gain from attending the Academy?*

What Experience have you had with Law Enforcement?*


Please Explain*

Authority of Conduct Background Investigation

As an applicant to participate in the Springfield Citizen Police Academy, I hereby authorize the Springfield Police Department to conduct a criminal history background investigation. I understand that such background investigation is routine, required for admission, and is conducted due to the content of the classes given at the Academy.

I understand that all available police and criminal records will be checked and that resulting information will be used in determining eligibility of applicants for the Citizen Police Academy. All information is to remain confidential as required by Illinois and Federal statutes.

I acknowledge that checking this box is considered legal binding signiture in the State of Illinois, and agree to undergo the Authority of Conduct Background Investigation. (5/21/2018)*

Student Agreement

I understand that class space is limited, therefore I agreed to attend at least eight (8) of the ten (10) scheduled sessions. Additionally, I agree to arrive promptly and to complete and return the evaluation forms provided for each session.

I acknowledge that checking this box is considered legal binding signiture in the State of Illinois, and agree to attend at least eight (8) of the ten (10) scheduled sessions. Additionally, I agree to arrive promptly and to complete and return the evaluation forms provided for each session. (5/21/2018)*