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Marion County Community Academy

Thank you for your interest in our Community Academy. Please fill out the following information to be considered for participation.

Your Information

1. Full Name:*
2. Other names used (Please include all names used, married and maiden)
3. Address*
4. Phone Number*
5. Date of Birth*
6. Email Address*
7. Driver's License or Oregon ID Card Number*

Please provide your current employer information

8. Company*
9. Your Job title
10. Company Address
11. Supervisor Name
12. Supervisor Phone Number or Email Address

Please provide three personal references who have known you at least two years

13. Reference Name and Phone Number or Email Address *
14. Reference Name and Phone Number or Email Address *
15. Reference Name and Phone Number or Email Address*

Additional Information

16. Have you ever been convicted of a criminal offense?*
17. Have you ever had any misdemeanor arrests?*
18. Please provide emergency contact information to include name, relationship, and contact information.*
19. Please explain why you would like to participate in the Community Academy.*
20. Please describe any positive or negative experience you have had with law enforcement.*

Acknowledge, Sign, and Submit

21. Authorization to conduct a background investigation*
As an applicant to participate in the Marion County Sheriff’s Office Community Academy, I authorize the Marion County Sheriff’s Office to conduct a criminal history background investigation. I understand such a background is being conducted due to the content discussed and location of the classes offered as part of the academy. I understand all available police and criminal records will be checked and the information will be used in determining my eligibility to attend the Community Academy. All information will remain confidential as required by state and federal statutes.

I acknowledge the information above and give permission to complete a background check.
22. Release, Indemnification, and Hold Harmless Agreement*
The applicant listed on this application, in consideration for the privilege of being a participant in the Marion County Sheriff’s Office Community Academy and recognizing that such an activity involves certain inherent risks and dangers, does hereby agree to assume all risks related to activities arising from, or associated with, participation in the program. The applicant, on their own behalf and their legal representatives, heirs and assigns, does hereby release, waive, discharge and hold harmless the County of Marion, its officers, employees, agents, and volunteers from any and all liability for any loss or damage or any claim for damages resulting in their participation in the Marion County Sheriff’s Office Community Academy, on account of any injury to their person or property, whether caused by negligence of the Marion County Sheriff’s Office, its officers, employees, agents or otherwise while participating in the Community Academy at the Marion County Sheriff's Office.

I acknowledge and agree to the information contained in the Hold Harmless Agreement.
23. Photo Release*
I hereby grant the Marion County Sheriff’s Office permission to use my likeness in a photograph in all of its publications, including website entries, without payment or any other consideration. I understand and agree that these materials will become the property of Marion County Sheriff’s Office and will not be returned. I hereby irrevocably authorize Marion County Sheriff’s Office to edit, alter, copy, exhibit, publish, or distribute photos for purposes of publicizing Marion County’s Sheriff’s Office programs or for any other lawful purpose. In addition, I waive the right to inspect or approve the finished product, including written or electronic copy, wherein my likeness appears.

I acknowledge and agree to the information contained in the Photo Release.
24. Student Agreement*
  • I understand that space is limited, and I will make every effort to attend all scheduled classes. I agree to arrive promptly, complete and return evaluations provided at each session, and inform course coordinators if I am going to be absent.
  • I understand the Community Academy provides a comprehensive sampling of police work; however, it is not a forum for training police officers.
  • I understand the Community Academy is not a degree-granting establishment; therefore, the completion of the academy does not provide educational credits.
I acknowledge and agree to the information contained in the Student Agreement.
25. I certify that the information provided is true, complete, and accurate to the best of my knowledge.*
Signature (Enter full name)
IP address will be included with signature
* required