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CITIZENS POLICE ACADEMY APPLICATION
P.O. BOX 8032
SAVANNAH, GA. 31412
SIDE ONE
Print Full name :
Home Address :
Home Phone:
Work:
Cellular/Pager:
City:
State:
Zip:
Date of Birth:
Sex:
Race:
SSN #:
Employer:
Occupation:
Education: High School / GED:
College / Technical School:
In Case of Emergency Contact:
Relationship :
Phone Number:
REFERENCES BELOW
Name:
Address :
Phone:
Name:
Address:
Phone:
Name:
Address:
Email Address:
Phone
SIDE TWO
How did you learn of the Citizens Police Academy ?
Are you currently a member of a Neighborhood Watch, Community Association, or other
Citizen Group ?
If Yes, which group ?
Participants in the Citizens Police Academy classes may be photographed, filmed, and / or
names used in promotional activities of the Savannah-Chatham Metropolitan Police
Department. Your Signature gives us the permission to use these without compensation:
Signature:
DATE:
Have you ever been arrested or convicted of a Crime?
If yes, please explain:
CONSENT FOR BACKGROUND CHECK
Information presented at the Citizens Police Academy is of a sensitive nature to Law
Enforcement; therefore we must ensure confidentiality by requiring all applicants to submit to a
Criminal History Records Check:
I, ___________________________________________________________(Print your name clearly )
hereby authorize the director of the Citizens Police Academy to receive any criminal history record
information pertaining to the individual identified above, which may be in the files of any state or
Criminal Justice Agency in the State of Georgia.
Signature:
Date:
Notary :
Date:
* $ 10.00 Registration fee must accompany any completed application. Checks or money orders may be
submitted and made out to the order of, The Citizens Police Academy. Cash will not be accepted.
Applications must be notarized.
SCMPD Form 1040
Citizens Police Academy
Savannah-Chatham Metropolitan Police Department’s Citizens Police Academy is
a thirteen week program designed to allow the residents of our community to
informally interact with the members of the police department and the local
criminal justice system. Participants will meet officers from each unit of SavannahChatham Police who will explain the how and why of what they do and will feature
speakers from various agencies with whom they interact.
Highlights of the program have been the tour of the 911 Center, Chatham County
Jail, Firearms/Tactical Training, Traffic Stop role playing and an opportunity to do
a ride-a-long with a patrol officer.
The class meets on Thursday nights from 6:30 to 9:30 p.m. at the SavannahChatham Police Department Squad Room, 201 Habersham Street. The next class
starts Thursday, September 10, 2015. Registration is $10 for the 14-week course.
Only checks or money orders will be accepted – no cash please. For an
application, visit a Precinct near you or call Gianna Nelson at 651-2246. For those
with access to the Internet, an application can be found on the SCMPD website,
www.scmpd.org. Please make sure your application is signed and notarized.
Applicants can turn in the application at any precinct or the Police Barracks at
Habersham and Oglethorpe Streets.
Graduates will receive a certificate of completion for Savannah Chatham
Metropolitan Police Department and will be eligible to apply to the Volunteers in
Policing Program if they want to support SCMPD through volunteering efforts.
Application deadline is Friday, September 4, 2015