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2. APPLICATION YORK-POQUOSON SHERIFF’S OFFICE “SHERIFF’S CITIZEN ACADEMY” YORKTOWN, VA
4. RON MONTGOMERY, SHERIFF

   Applicants must be 21 years of age to apply and live or work in York County or the City of Poquoson. Incomplete and/or unsigned applications will not be considered.

6. Name*
7. Date of Birth:*
   Date of Birth:
8. Sex*
   -- Select One --MaleFemale
10. Address*
12. City*
13. State*
14. Zip Code*
16. Home Phone:
17. Work Phone:
19. Email Address:*
20. Cell Phone:
22. Driver License Number:
23. Last 4 digits of SSN:*
25. Employer:
26. Occupation:
28. Employers Address:
30. City
31. State
32. Zip Code
34. Have you been arrested for any offense other than traffic?*

    1. Yes
    2. No
35. If yes, what for?
37. When?
38. Where?
40. What was the outcome?
42. What do you expect to gain from attending this program?
44. Will you be able to attend all 12 sessions?*

    1. Yes
    2. No
45. Shirt Size? (Male Polo Sizes)*

    1. S
    2. M
    3. L

    1. XL
    2. 2XL
    3. 3XL
47. I hereby certify that the information contained in this application is true and correct to the best of my knowledge. The Sheriff’s Office is hereby authorized to conduct an investigation of my criminal and driving history as deemed necessary for consideration to attend the Sheriff’s Citizen Academy.
49. Electronic Signature of Applicant:*
    Applicants will sign hard copies of documents upon acceptance.
50. Today's Date:*
    Today's Date:
Leave This Blank:


52. 1. Receive an email copy of this form.
53. Email address

    This field is not part of the form submission.

54. Submit

* indicates a required field