Citizens' Academy Application Please print this application, supply all information, and return it to: Lynnwood Police Department Citizens' Academy P.O. Box 5008 Lynnwood, WA 98046-5008

Full Legal Name: ____________________________________________________   Last              First              Middle Initial Address: ____________________________________________________   Street   ____________________________________________________   City,              State              ZIP Code Telephone: _________________________ Home _________________________ Work Date of Birth: _________ / _________ / _________   Month      Day        Year Driver's License #: __________________________   Would you please tell us why you are interested in attending the Lynnwood Police Department's Citizens' Academy?   _____________________________________________________________________   _____________________________________________________________________   _____________________________________________________________________   _____________________________________________________________________   _____________________________________________________________________   _____________________________________________________________________   _____________________________________________________________________   I, _________________________________________________, authorize the Lynnwood Police Department and its agents and employees to conduct a review of the records of the Lynnwood Police Department and other law enforcement agencies for the purpose of confirming that I am of good character. I hereby release the City of Lynnwood and all its agents and employees from any liability which may arise out of the background investigation and recommendations, including liability from negative recommendation based on erroneous information.   Dated this _______________ day of ________________, ___________   Signature: ____________________________________________________