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LANSING POLICE DEPARTMENT Citizens' Police Academy Application

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2. Step Two This section is complete This section is incomplete
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4. Step Four This section is complete This section is incomplete

Step One

LANSING POLICE DEPARTMENT CITIZENS' POLICE ACADEMY APPLICATION (Page 1)
Name*
Street Address, City, State, and Zip Code*
Home Phone Number
Cell Phone Number
Date of Birth
Drivers License Number
How long have you lived at your address?
Why do you want to attend the Lansing Police Department Citizens' Police Academy?
Clubs and Organizations
List any clubs and organizations you belong to
Current Employer
Current Employer's Street Address, City, State, and Zip Code
Current Supervisor's Name
Current Work Phone Number
Have you ever been fired or resigned from a job within the last five years?
1. Yes
Have you ever been fired or resigned from a job within the last five years?
1. No
Hire Date
If yes, please explain
Name of Employer at the job you resigned or were fired from
Supervisor's Name at the job you resigned or were fired from
Street Address, City, State, and Zip Code at the job you resigned or were fired from
Phone Number at the Job you resigned or were fired from
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Step Two

LANSING POLICE DEPARTMENT CITIZENS' POLICE ACADEMY STATEMENT OF UNDERSTANDING (Page 2)
List one immediate family member or close friend that can be contacted in the event of an emergency
Home Phone Number
Cell Phone Number
Please review your answers carefully and read the statement below before signing this application
"I hereby certify that there are no willful misrepresentations, omissions or falsifications in the foregoing statements and answers to questions. I understand that any omission or false statements on this application shall be sufficient cause for rejection from the Lansing Citizens' Police Academy. I further understand that the Lansing Police Department will be conducting a thorough background investigation that may include, but not be limited to, any criminal history, employment history, and personal references. I understand that the Citizens' Police Academy consists of multiple weeks and remain prepared to fulfill the commitment barring unexpected priorities. I recognize that information will be shared with me regarding police processes, equipment, personnel, and tactics that are not commonly shared with the general public. I agree to treat all newly gained knowledge professionally and remain cognizant of what and with whom I share these experiences. I also recognize that the Citizens' Police Academy has physically interactive portions where full participation is strongly encouraged for maximum benefit." The Lansing Police Department retains the right to accept or refuse applicants for any reason.
"I hereby certify that there are no willful misrepresentations, omissions or falsifications in the foregoing statements and answers to questions. I understand that any omission or false statements on this application shall be sufficient cause for rejection from the Lansing Citizens' Police Academy. I further understand that the Lansing Police Department will be conducting a thorough background investigation that may include, but not be limited to, any criminal history, employment history, and personal references. I understand that the Citizens' Police Academy consists of multiple weeks and remain prepared to fulfill the commitment barring unexpected priorities. I recognize that information will be shared with me regarding police processes, equipment, personnel, and tactics that are not commonly shared with the general public. I agree to treat all newly gained knowledge professionally and remain cognizant of what and with whom I share these experiences. I also recognize that the Citizens' Police Academy has physically interactive portions where full participation is strongly encouraged for maximum benefit." The Lansing Police Department retains the right to accept or refuse applicants for any reason.
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.
1. I agree.
Electronic Signature*
Date
Date
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Step Three

LANSING POLICE DEPARTMENT RIDE-ALONG OBSERVER APPLICATION (Page 3)
Instructions
The Ride-Along Program is designed for Lansing residents and those seeking employment with the Lansing Police Department. Residents may ride once every six months. Ride-Alongs are scheduled four hours in duration.
By completing and signing this application, the applicant agrees to the following:
A "Waiver of Liability must be signed prior to participation in the Ride-Along Program. Persons under the age of 18 must have written parental or legal guardian endorsement in addition to the "Waiver of Liability" prior to participation. Disclosure of any medical, mental, or emotional condition that could be compromised by participation. The observation ride may be terminated by the officer at any time due to unusual or hazardous duty conditions or to misconduct on the part of the observer. The observer may request termination of the observation ride at any time. The officer will honor the request as soon as possible. No firearms or other weapons, include mace/pepper spray, may be carried by an observer, with the exception of sworn or LEOSA certified observers. Observers are prohibited from taking any cell phone or other digital photos/videos. The observer's dress must be in good taste, consistent with community standards, business casual. For their own safety, observers must comply with the directions of the officer and are discouraged from entering into, handling, or otherwise engaging in known hazardous situations. The observer understands that certain information obtained during the ride-along may be sensitive or highly confidential and agrees not to share outside of this experience. Observers may be subpoenaed to court to testify as a res gestae witness regarding observations at particular incidents. Family members wishing to ride with an officer MUST HAVE PRIOR WRITTEN AUTHORITY FROM A PATROL LIEUTENANT.
A "Waiver of Liability must be signed prior to participation in the Ride-Along Program. Persons under the age of 18 must have written parental or legal guardian endorsement in addition to the "Waiver of Liability" prior to participation. Disclosure of any medical, mental, or emotional condition that could be compromised by participation. The observation ride may be terminated by the officer at any time due to unusual or hazardous duty conditions or to misconduct on the part of the observer. The observer may request termination of the observation ride at any time. The officer will honor the request as soon as possible. No firearms or other weapons, include mace/pepper spray, may be carried by an observer, with the exception of sworn or LEOSA certified observers. Observers are prohibited from taking any cell phone or other digital photos/videos. The observer's dress must be in good taste, consistent with community standards, business casual. For their own safety, observers must comply with the directions of the officer and are discouraged from entering into, handling, or otherwise engaging in known hazardous situations. The observer understands that certain information obtained during the ride-along may be sensitive or highly confidential and agrees not to share outside of this experience. Observers may be subpoenaed to court to testify as a res gestae witness regarding observations at particular incidents. Family members wishing to ride with an officer MUST HAVE PRIOR WRITTEN AUTHORITY FROM A PATROL LIEUTENANT.
Name
Street Address, City, State, and Zip Code
Email Address
Home Phone Number
Cell Phone Number
Driver's License Number
Date of Birth
State
Agreement and Signature
I have read and agree to comply with the rules applicable to the Ride-Along Observer Program.
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.
1. I agree.
Electronic Signature*
Date
Date
RIDE-ALONG SHIFT ASSIGNMENT
Shift
Date and Time
Date and Time
Date and Time
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Step Four

LANSING POLICE DEPARTMENT RIDE-ALONG OBSERVER WAIVER OF LIABILITY AND COVENANT NOT TO SUE (Page 4)
Waiver and Covenant Not to Sue
I have asked to be allowed to accompany Lansing Police Officers in the course of their duties and to ride in a vehicle operated by an Officer of the Lansing Police Department. I hereby agree, both on my own behalf and on behalf of my heirs and assigns, that the City of Lansing, its Employees, Agents, and Sureties will not be held, in any way, for any loss, injury, exposure to communicable diseases, or other damage to me or to my property which may occur as a result of or in the course of my accompaniment of Lansing Police Officers in the course of their duties or my presence in a Lansing Police vehicle due to any cause including negligent act or failure to act by a member of the Lansing Police Department or any other person. I also agree on my own behalf and on behalf of my heirs and assigns that I will not sue the City of Lansing or any of its Employees, Agents, or Sureties for any such loss, injury, or damage to me or my property arising from my presence in a Lansing Police Department vehicle and with Lansing Police Department Officers during the course of their duties. I understand that the work of the Lansing Police Department may, at times, be dangerous and that by accompanying Lansing Police Department Officers as a “Ride-Along” guest, I may be exposing myself and my property to significant danger, injury, damage, or other loss. I also understand that this may include and exposure to blood, bodily fluids, communicable disease, or other potential biohazard. I also understand that I am being allowed to accompany Lansing Police Department Officers in the course of their duties and ride in a Lansing Police Department vehicle strictly as a guest and observer and that I am not to be involved in their duties in any way at any time unless specifically requested by them. I also agree to follow any directions from the Officer relating to the use of any cleansing agents or decontamination procedures. I agree to defend, indemnify, and hold harmless the City of Lansing, its Officers, Agents, and Employees, against any and all suits or claims for damages and/or losses incurred while accompanying Lansing Police Department Officers in the course of their duties and while riding in a Lansing Police Department vehicle as a guest in the “Ride-Along” program. I further agree to waive any liability or cause of action against the City of Lansing on behalf of myself, my heirs, successors, assigns, attorneys, and insurers.
I have asked to be allowed to accompany Lansing Police Officers in the course of their duties and to ride in a vehicle operated by an Officer of the Lansing Police Department. I hereby agree, both on my own behalf and on behalf of my heirs and assigns, that the City of Lansing, its Employees, Agents, and Sureties will not be held, in any way, for any loss, injury, exposure to communicable diseases, or other damage to me or to my property which may occur as a result of or in the course of my accompaniment of Lansing Police Officers in the course of their duties or my presence in a Lansing Police vehicle due to any cause including negligent act or failure to act by a member of the Lansing Police Department or any other person. I also agree on my own behalf and on behalf of my heirs and assigns that I will not sue the City of Lansing or any of its Employees, Agents, or Sureties for any such loss, injury, or damage to me or my property arising from my presence in a Lansing Police Department vehicle and with Lansing Police Department Officers during the course of their duties. I understand that the work of the Lansing Police Department may, at times, be dangerous and that by accompanying Lansing Police Department Officers as a “Ride-Along” guest, I may be exposing myself and my property to significant danger, injury, damage, or other loss. I also understand that this may include and exposure to blood, bodily fluids, communicable disease, or other potential biohazard. I also understand that I am being allowed to accompany Lansing Police Department Officers in the course of their duties and ride in a Lansing Police Department vehicle strictly as a guest and observer and that I am not to be involved in their duties in any way at any time unless specifically requested by them. I also agree to follow any directions from the Officer relating to the use of any cleansing agents or decontamination procedures. I agree to defend, indemnify, and hold harmless the City of Lansing, its Officers, Agents, and Employees, against any and all suits or claims for damages and/or losses incurred while accompanying Lansing Police Department Officers in the course of their duties and while riding in a Lansing Police Department vehicle as a guest in the “Ride-Along” program. I further agree to waive any liability or cause of action against the City of Lansing on behalf of myself, my heirs, successors, assigns, attorneys, and insurers.
Understanding
I HAVE FULLY READ AND UNDERSTAND THE CONTENTS OF THIS WAIVER OF LIABILITY AND COVENANT NOT TO SUE AND UNDERSTAND THAT BY PLACING MY SIGNATURE BELOW I AM AGREEING TO ITS TERMS.
Witness Name*
Date
Date
Signature of Ride-Along Guest
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.
1. I agree.
Electronic Signature*
Date
Date
Signature of Parent or Guardian
If guest is under the 18 years of age
Instructions for Parent or Guardian
If Ride-Along guest is under eighteen (18) years of age, this Waiver of Liability and Covenant Not to Sue must be signed by the Ride-Along guest's parent or guardian.
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.
1. I agree.
Electronic Signature
Date
Date
Approved by
Date
Date

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LANSING POLICE DEPARTMENT Citizens' Police Academy Application

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