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Davidson County Sheriff’s Office

2511 E US Hwy 64 Lexington, NC 27292

“Making Davidson County a Better and Safer Place”

Sheriff

Richie Simmons

Emergencies: Dial 911

Phone: 336-242-2105

Fax: 336-242-3091

Application: Davidson County Sheriff’s Office Citizens Academy 2022

First and Last Name:

* First Name:	* Last Name:

* Date of Birth:

* Driver`s License Number:

* Address:

City, State, Zip Code:

* City:	* State:	* Zip Code:

Telephone:

* E-mail:

List any medications or allergies we may need to know about:

Emergency Contact Name:

Emergency Contact Phone:

Have you ever been convicted of a criminal offense or have current criminal charges pending other than traffic infractions? If yes, please explain.

If you checked College/University or Graduate School above, please enter the name of the institution:

Please enter your major and/or degree achieved:

Current employment or occupation (including retired, unemployed, student, homemaker, etc.):

Special skills or interests:

List any associations, clubs or organizations you may belong to:

Do you know anyone involved in law enforcement? If so, who?

Have you ever had a direct contact with this law enforcement agency? Either for a traffic violation, reporting a crime, needing assistance, etc. If so, why and what was your impression of the conduct of the officers?

How did you hear about the Davidson County Sheriff`s Office Citizens Police Academy?

Reasons for your interests in the Davidson County Sheriff`s Office Citizens Academy:

Today`s Date:

I hereby acknowledge that I have completed the above information fully and accurately. I understand and give my permission, with respect to the Davidson County Sheriff’s Office, to conduct a background investigation to determine my suitability for admission to the Davidson County Sheriff’s Office Citizens Academy.

Please type how you normally sign your name.