BASTROP COUNTY CITIZEN SHERIFF’S ACADEMY

                                                           APPLICATION FOR STUDENT ENROLLMENT

                              (Right click, copy and paste in MS Word, everything that is in blue and you can fill out the application, sign it and mail it)

 

 

All student applications must be completed and returned to the Sheriff’s Office in order to be considered. There are only 30 openings in each academy class, therefore, not every application will be accepted. An eligibility list will be established for last minute cancellations and openings in future academy classes

Applications may be picked  up at the Bastrop County Sheriff's Office. Classes will be announced in the Bastrop Advertiser  or you can call  Wayne Wood at 512-549-5069 or email wayne.wood @co.bastrop.tx.us  for future dates.

Name:_________________________________________________________________________(last,first, middle initial)

Mailing Address________________________________________________________________________Zip Code______________

Home Address__________________________________________________________________________Zip Code______________

Residence County___________________________________ Home phone___________-_______________________________

Place of employment:__________________________________________________Occupation_________________________

Work phone:______________________________________________

Memberships in Community Groups, Civic Organizations, ETC.

_____________________________________________________________________________________________________________________

 

How did you hear about the Sheriff’s Citizen Academy?

_____________________________________________________________________________________________________________________

What is your objective in enrolling in the Citizen Academy and why should you be considered for the Academy?

______________________________________________________________________________________________________________________

If you are accepted as a student, you will receive instruction and educational materials related to the law enforcement mission of Bastrop County Sheriff’s Office. As such, some of the material presented will be privileged, or confidential, in nature. Due to the sensitivity of this information, it is necessary for the Bastrop County Sheriff’s   Office to conduct background checks to determine the suitability of those persons desiring to attend academy classes. Please answer the following questions accurately and completely as possible. Any intentional misrepresentation or omission of facts will be grounds for denial of admission to the academy, or if enrolled, immediate termination from the program.

A criminal history check will be made on all persons enrolling in the Bastrop County Citizen Sheriff’s Academy.

                      

Drivers License (State and Number)                                                       Social Security Number

________________________________________________                                                ______________________________________

 

Do you go by any other names or aliases now or have you in the past?   _____Yes  _____No

 If yes, explain :  (Do NOT include maiden name unless used in the past 3 years)    

_________________________________________________________________________________________________________________________

_________________________________________________________________________________________________________________________

 

Are you a member of or have you ever been affiliated with a Law Enforcement Agency? ____Yes ____No

 If yes, explain:

 

Have you lived outside of the United States (or its territories) in excess of 90 days?  _____Yes _____No

 If yes explain: (Do NOT include Military Service Overseas.

 

Have you ever been convicted of a felony or are you currently on probation/parole for any offense?  _____Yes   ______NO         If yes explain:

 

Name and telephone number of person to contact  in an emergency:_______________________________________________________________________________________________________

Relationship:____________________________________________

                                                  APPLICANT MUST COMPLETE THE FOLLOWING:

I, ______________________________________________________hereby acknowledge that I have completed the above application completely and accurately to the best of my knowledge, I also acknowledge that the Bastrop County Sheriff’s Office will be conducting a background investigation on me to determine my suitability for admission to this program. Permission is hereby granted to conduct a background investigation based on the information given in this application.

__________________________________________________                                                            ________________________________

Signature of applicant                                                                                                            Date    

               Bring or Mail to Bastrop County Sheriff’s Office  200 Jackson St. Bastrop, Tx. 78602  

                                                Attention - Deputy Robert Williams / Crime Prevention

 

 

 

 

                                                                                 

 

                                                                               

 

 

  

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

                                                                 

                     

                                                                

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

                                                                        

 

           

 

 

                                                                                                                                                                                               

 

 

 

 

 

 

 

 

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