Welcome to the Harlan County Sheriff's Office Citizens Academy

MISSION STATEMENT

MEET THE SHERIFF

SIGN-UP FORM

Please fill out the form below with correct and accurate information. Applications for the first Citizens Academy are on a first come first serve basis. IMPORTANT: A background investigation on you will be conducted upon submission of this application. Any criminal convictions, any previous actions which could reflect unfavorably on the Harlan County Sheriff's Office, any attempt to deceive or conceal pertinent information, will be cause for denial of this application. Please fill in all fields marked with an *

Today's Date*
Email Address*
First Name*
Middle Name
Last Name*
Date Of Birth*
Sex*	Female Male
Race*	White Black Other
Address* No P.O. Boxes
City*
State*
Zip*
Home Phone*
Cell or Alternate Phone*
Ever Been Arrested*	Yes No If yes, you must fax the following information to the Sheriff's Office at 606-573-2001 in order to be considered as a student: Copy of arrest form showing clearly the arresting agency, their case number and the charges, and a copy of court documents showing the outcome of the charges.
If Yes, Please explain the circumstance
Any Physical Limitations
Why I want to attend
Emergency Contact*