EVESHAM POLICE DEPARTMENT Junior Police Academy Application

EVESHAM POLICE DEPARTMENT Junior Police Academy Application
PERSONAL
Name:
Date of Birth:

MonthDayYear
Date
Age:
Home Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Home Phone:
Format: (000) 000-0000.
Cell Phone:
Format: (000) 000-0000.
Mother's Name:
Father's Name:
Mother's Cell Phone:
Format: (000) 000-0000.
Father's Cell Phone:
Format: (000) 000-0000.
Mother's e-mail address:
example@example.com
Father's e-mail address
example@example.com
**Email will be utilized for most communication for parent information.
EDUCATION
Name of School enrolled:
Highest Grade Completed:
Name of Principal:
School Phone:
Format: (000) 000-0000.
BACKGROUND
Please upload a recent photo of the applicant.
File Upload

Cancelof
1|Page
EVESHAM POLICE DEPARTMENTJunior Police Academy Application
Please explain briefly why you wish to be enrolled in the Evesham Township Police Department Junior Police Academy. (Space Available on last page if necessary)
Have you ever been a cadet in this academy before? If yes, please state when:
Please list any associations, clubs, organizations you may belong to or be affiliated with.
Have you ever been arrested for, convicted of, and or cited for any offense?
If yes, explain in detail listing appropriate dates, charges, and location actions were taken.
If yes, explain in detail listing appropriate dates, charges, and location actions were taken.
EVESHAM POLICE DEPARTMENT Junior Police Academy Application
EMERGENCY CONTACTS
Please list two immediate family members or close relatives that can be contacted in the event of an emergency.
Emergency Contact #1 - Name:
Relationship:
Address:
Phone:
Format: (000) 000-0000.
Emergency Contact #2 - Name:
Relationship:
Address:
Phone:
Format: (000) 000-0000.
SPONSOR
Attach a letter provided by the selected sponsor.
(Principal / Guidance Department, Law Enforcement Agency, a community representative, coach, or religious leader.)
File Upload

Cancelof
Sponsor's Name:
Sponsor's Position:
Address of Sponsor:
Phone Number:
Format: (000) 000-0000.
REFERENCES
Reference #1 Name:
Relationship:
Address:
Phone Number:
Format: (000) 000-0000.
Reference #2 Name:
EVESHAM POLICE DEPARTMENT Junior Police Academy Application
Relationship:
Address:
Phone Number:
Format: (000) 000-0000.
MEDICAL INFORMATION
This information is given voluntarily and is part of my health record maintained by the Evesham Township Police Department. This information will be kept confidential and referred only in the event of an emergency.
Please list any medications either prescribed or over the counter that you are currently taking. Describe the purpose the medications are prescribed.
Describe any Allergies You May Have:
Describe any Religious Accommodations Needed:
Junior Police Academy Application
Uniforms
Select 1 size for T-shirt. All Cadets must wear all black shorts or pants. Bottoms must be provided by the parent.
SMLXL
YouthAdult
Academy preference: Please select your preferred academy session below. While we will make every effort to accommodate your selection, placement in a specific session is not guaranteed.
July 20th through July 24thAugust 10th through August 14th
Cadets must be able to attend all 5 days of the academy to be accepted. Please advise the officer in charge if your child is unable to attend all 5 days.
Please utilize this section for any additional information.
EVESHAM POLICE DEPARTMENT Junior Police Academy Application
Review this application and answer carefully. Read the statement below prior to signing.
"I hereby certify that there are no willful misrepresentations, omissions, or falsifications in the foregoing statements and answers to the questions. I understand that any omissions or false statements on this application shall be sufficient cause for rejections of enrollment or dismissal from the Evesham Township Department Junior Police Academy."
"I further understand that the Evesham Township Police Department will be conducting a thorough background investigation which may include, but not limiting to, any criminal history and personal references checks."
Signature

Clear
Date

MonthDayYear
Date
6|Page
Should be Empty:

EVESHAM POLICE DEPARTMENT Junior Police Academy Application

PERSONAL

EDUCATION

BACKGROUND

EVESHAM POLICE DEPARTMENTJunior Police Academy Application

EVESHAM POLICE DEPARTMENT Junior Police Academy Application

EMERGENCY CONTACTS

SPONSOR

REFERENCES

EVESHAM POLICE DEPARTMENT Junior Police Academy Application

MEDICAL INFORMATION

Junior Police Academy Application

Uniforms

EVESHAM POLICE DEPARTMENT Junior Police Academy Application