Community Partnership Academy Application

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Name*

First NameLast Name

Email*

example@example.com

Address*

Street Address

Street Address Line 2

CityState

Zip Code

Driver's License*

Driver's License State*

Driver's License Expiration Date*

Cell Phone Number*

Please enter a valid phone number.Format: (000) 000-0000.

Birth Date*

Employer Name*

Job Title*

Employer Address*

Length of Employment*

How did you hear about the Academy?

Why do you want to attend the Academy? *

YesNo

What was your personal experience with SJPD?

Please describe.

YesNo

Please provide dates you cannot attend?

YesNo

Please provide details of your previous arrest(s) (date, location, incident, summary, disposition)

YesNo

Please provide details of your non-traffic related citation(s) (date, location, incident, summary, disposition)

YesNo

Please provide details of the charges and disposition(s) that may have included custody time and/or periods of supervision on Probation or Parole.

YesNo

Eligibility Requirements

Applicants for the Community Partnership Academy must meet the following criteria:

Be at least 18 years of Age
Be able to speak and understand English
A resident of the City of San Jose (or have strong ties to the city)
Have the physical ability to participate in scenario-based training and other academy activities
Willing to undergo a soft background check
Not convicted of any Felony offenses, or any Misdemeanor offenses that involve serious, violent or sexual behavior
Not convicted of a Misdemeanor within one year of application and all contact (such as traffic violations or any arrest with any law enforcement agency during the class) must be reported to the class coordinator as soon as possible.
Any of the above requirements may be waived or modified upon review by the program review board.

PRIVACY AGREEMENT
Please be advised that any information you provide in the City of San José’s Police Department Community Partnership Academy application will be retained by the City of San José. Please note that the City of San José holds all confidential information in the strictest of confidence and does not disclose or provide access to confidential information to unauthorized persons, unless required by law. The privacy of our applicants is very important to us. We take precautions to protect your personal information by using a variety of security measures to reduce the risk of loss, misuse, unauthorized access, disclosure or modification of your information.

CITY OF SAN JOSÉ POLICE DEPARTMENT COMMUNITY PARTNERSHIP ACADEMY AGREEMENT AND RELEASE OF LIABILITY

My name is:

I am at least 18 years old. I am voluntarily participating in the San José Police Department Community Partnership Academy. I understand that I will participate in classroom instruction, scenario-based training and visit police facilities while in the company of a San José Police Officer or San Jose Police Department employee.*

Enter Your Initials

I understand that the hazards of the Community Partnership Academy include, but are not limited to, injury, illness, death, or damage to my personal property. I am voluntarily participating in the Community Partnership Academy with full knowledge of the risks involved, and I agree to accept any and all risks of injury, illness, death, or damage to my personal property.*

Enter Your Initials

In consideration of my participation in the Community Partnership Academy, I agree that I, my heirs, guardians, legal representatives, and assigns will not make a claim against, or sue the City of San José, its officers, agents, or employees for injury, illness, death, or damage to my personal property arising from the negligence or other acts by the City of San José, its officers, agents, or employees, or as a result of the acts of third-parties, as a result of my participation in the Community Partnership Academy. *

Enter Your Initials

In addition, I release and discharge the City of San José, its officers, agents, and employees from all actions, claims, or demands that I, my heirs, guardians, legal representatives, or assigns now have or may have later for injury, illness, death, or damage to my personal property resulting from my participation in the Community Partnership Academy.*

Enter Your Initials

I agree to be bound by all orders, rules, and regulations concerning my participation in the Community Partnership Academy and to promptly obey all instructions of the Police Department personnel to whom I am assigned. *

Enter Your Initials

I will not make any recording of any kind during the Community Partnership Academy, including audio, video, or photographs.*

Enter Your Initials

I authorize the San José Police Department to conduct a comprehensive review of my background. I understand that the scope of this records check may include, but is not limited to, warrants and criminal history records. I understand certain findings may restrict my ability to participate in the Community Partnership Academy. *

Enter Your Initials

This agreement and release of liability are intended to be binding upon any heirs, guardians, legal representatives, and assigns.

I HAVE CAREFULLY READ THIS DOCUMENT AND FULLY UNDERSTAND ITS CONTENTS. I AM AWARE THAT THIS IS A RELEASE OF LIABILITY AND I SIGN IT VOLUNTARILY.

Participant Signature

Signed On

Today's Date