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Application - Citizen Police Academy

  1. Do you have a valid Driver's License
  2. I certify that I am over the age of 18 years of age*
  3. Do you have any medical conditions or allergies that may affect your ability to participate in this program*
  4. I hereby certify that all entries and attachments are true and complete, and I agree and understand that any falsification of information herein, regardless of time of discovery, may cause forfeiture on my part of participation in the Citizen's Police Academy.  I understand that all information on this application is subect to verfication and I consent to criminal history, driving and financial background checks.  I also consent that you may contact references, former employers and educational institutions listed regarding this application.  I further authorize the City of Radford to rely upon and use, as it sees fit, any information received from such contacts.  Information contained on this application may be disseminated to other agencies, nongovernmental organizations or systems on a need-to-know basis for good cause shown as determined by the agency head or designee.

  5. Electronic Signature Agreement
    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.
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