NJ TRANSIT POLICE 1 Penn Plaza East 7 th Floor Newark, NJ ATTN: TRAINING UNIT

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1 Citizen Police Academy Application Thank you for your interest in the NJ TRANSIT Police Citizen Police Academy. Attached is an application for the program. The NJTPD Citizen Police Academy is an exciting opportunity for citizens to not only learn about police work in general, but also to get an understanding of the NJ Transit Police Department s responsibilities, capabilities and structure. This course is for informational purposes only and is not a part of the application process for employment as a police officer with NJ TRANSIT Police. If accepted into the program, students are allowed two excused absences. Upon a third absence, you may be removed from the program upon the discretion of the course organizers. Please COMPLETELY fill out the application and all attached forms in black or blue pen. Once you have completed the application in its entirety, you MUST have the application notarized in all the areas indicated. Any incomplete and/or un-notarized applications will be rejected. Send the ORIGINAL notarized application via mail or intra-office mail to: NJ TRANSIT POLICE 1 Penn Plaza East 7 th Floor Newark, NJ ATTN: TRAINING UNIT You will be notified of your application s status once a complete and thorough background check has been completed. Any applicants that are untruthful on their application will be denied access into the program If you have any questions, contact the NJ TRANSIT Police Training (973)

2 Citizen Police Academy Application Last Name: First: M.I.: Date of Birth: / / Age: Social Security Number: - - Sex: Male Female US Citizen: YES NO Marital Status: Single Married Separated Divorced Widowed Home Address: Number Street City State Zip Home Telephone #: - - Cell Phone #: - - Address: (Work): (Home) Present Employer: Name/Company Address City/Town State/Zip Occupation: Work Telephone: - - Highest Level of Education: GED High School College Other College Degree(s) or Professional Licenses: Driver s License Number: Is Your Driver s License Currently Suspended or Revoked in New Jersey or another state? Yes No Have you ever been arrested for, charged with or convicted of an indictable crime, disorderly person, or a city or township ordinance violation? Yes No If yes, provide details of event, date, and disposition: List any civic organizations, activities or groups you belong to: Where/how did you learn of the Citizen s Police Academy?: 2

3 Certification I certify that all of the statements made in this application are true, complete and correct to the best of my knowledge and belief, and are made in good faith. I am aware that any misrepresentation of any information supplied by me will result in my disqualification from attending the New Jersey Transit Police Department Citizen Police Academy Class. I also understand that any criminal record will preclude me from participating in the Citizen Police Academy Class. Further, I hereby authorize the New Jersey Transit Police Department to verify any and all information contained herein and to review any employment, education, criminal history, motor vehicle record, and other records and information from any source as noted in this duly executed authorization and release form. I have read this Certification and I understand and agree to the conditions imposed herein. Date: Name: Signature: Print Name: STATE OF: COUNTY OF: SWORN TO AND SUBSCRIBED BEFORE ME THIS DAY OF, 20 (Print Name and Title) NOTARY PUBLIC, MY COMMISSION EXPIRES: DO NOT WRITE BELOW THIS LINE CLASS NUMBER RANKING RECEIVED CRIMINAL HISTORY MOTOR VEHICLE APPROVED REJECTED PIN 3

4 CITIZEN RIDE-ALONG PROGRAM RULES AND REGULATIONS DEFENSE AND HOLD HARMLESS AGREEMENT WHEREAS,, desires to observe member of the New Jersey Transit Police Department in the performance of their duties (hereinafter the Ride-Along Program ); and WHEREAS, in order to protect both the aforementioned individuals and the members of the New Jersey Transit Police Department it is necessary for any individual participating in the Ride-Along Program to comply with certain terms and conditions: NOW THEREFORE, in consideration of the ability to participate in the Ride-Along Program, and for other good and valuable consideration, the aforementioned civilian individual, represents and agrees as follows: 1. I am an adult of at least eighteen (18) years of age and I will produce photographic identification sufficient to establish same. 2. I understand that my participation in the Ride Along Program is limited to observation only, and that I may not interfere with any officer during the period of my participation in the Ride-Along Program. 3. I will not disclose any information observed or otherwise received during my participation in the Ride-Along Program, which may be case sensitive and confidential. 4. I am aware that any reports, notes and/or reproduced information, which I create or otherwise receive, will be screened by a police officer before the end of my participation in the Ride-Along Program. I am aware that I will not be permitted to utilize a recording device of any type or a camera during my participation in the Ride-Along Program. 5. The length of my participation in the Ride-Along Program is solely within the discretion of the officer. 6. I am aware that I may be discharged from the Ride-Along Program at any time, with or without cause. 7. I will dress in proper, professional attire during the period of my participation in the Ride-Along Program. 8. I will not exit the patrol vehicle at any time, unless instructed by the officer. 9. I am aware that for the safety of the officer(s), the public, and myself, I will follow the direction of the officer(s) and their supervisor(s). 10. I am physically able to participate and I am aware of no physical disability which would prevent me form participating in the Ride-Along Program. 11. I recognize that due to the nature of the work performed by the New Jersey Transit Police Department, there is a risk of my becoming injured 4

5 or a victim of a violent crime. As such, I will follow the instruction of the officer(s) at all times. 12. I will not communicate in any manner with any suspect or prisoner during my participation in the Ride-Along Program. Further, I will remain silent at the scene of any criminal act, occurrence, arrest or during the course of any police procedure. In full awareness of the above and in consideration of my participation in the Ride-Along Program, I hereby waive, release and discharge the New Jersey Transit Corporation, New Jersey Transit Police Department, its officers, agents and employees from any claim or loss for death, personal injury, emotional stress or property damage arising in any manner from the application process or my participation in the Ride-Along Program. Furthermore, I acknowledge the aforementioned risks are not intended to be exhaustive and I voluntarily accept all risks both known and unknown. Finally, it is understood and agreed that this waiver, release, indemnity and assumption of risk is intended to be binding on my heirs, executors, and assigns. BY SIGNING BELOW, I AGREE TO THE ABOVE TERMS AND CONDITION SET FORTH BY THE NEW JERSEY TRANSIT POLICE DEPARTMENT, THIS DAY OF,. Signature: Print Name: Subscribed and sworn to me this day of, Notary Public Approved: Date: Chief of Police 5