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BTB Application 2022-fillableBehind the Badge A Community Police Academy Sponsored Event 2022 Application Hosted by the Iowa City Police Department, Johnson County Sheriff’s Office, North Liberty Police Department and the University of Iowa Police Department Please type or print legibly in blue or black ink. Name: Address: First Middle Last Street Phone: City State Zip Code Cell/Home Work Date of Birth: Email: Driver’s License Number & State: Employer: Occupation: Employer’s Address: Street City State Zip Code Have you been arrested for any offense other than a traffic violation? Yes No If yes, what for? When? Where? Would you like to be considered for a scholarship? Yes No Please list any accommodations you need: Why do you want to attend the Behind the Badge Series? I hereby certify that the information in this application is true and complete to the best of my knowledge. You are authorized to make any investigation of my personal history deemed necessary of consideration to attend the Behind the Badge series. Applicant signature Date Behind the Badge 2022 Series Participant Instructions Hosted by the Iowa City Police Department, Johnson County Sheriff’s Office, North Liberty Police Department and the University of Iowa Police Department 1.The Behind the Badge shall not interfere with routine operations of any law enforcement agency. 2.The student shall not be armed at any time. 3.Participants who are asked to identify themselves should explain that they are a Behind the Badge participant. 4.Smoking is not allowed in any government building or vehicle. 5.A criminal records check will be conducted on all applicants prior to acceptance into the Academy. 6.All participants will conduct themselves in an appropriate and professional manner.7.Violation of any instruction, guideline, rule, or failure to comply with a reasonable request will terminate the individual’s participation in series. This is at the discretion of any member of the Iowa City, North Liberty, or University Police Departments, or Johnson County Sheriff’s Office. 8.All applicants must be at least 16 years of age by March 23rd, 2022. 9.Participants must adhere to the University of Iowa and Johnson County mask policies. 10.A $10 participation fee is required to cover the costs of materials and supplies. Please attach payment to this application. Checks are welcomed. Make checks payable to the City of Iowa City. In consideration of the above law enforcement agencies granting permission to enter in or upon any premises or vehicles which are under their actual care or constructive or passive control, I hereby waive all claims to damage or loss to my person or property which may be caused by any act, or failure to act, of the Iowa City, North Liberty and/or University Police Departments, and/or Johnson County Sheriff’s Office officers, agents or employees. I assume the risk of all dangerous conditions in, upon or about the premises or vehicles and waive any and all notice or existence of such conditions. I certify that I understand the requirements and responsibilities of participants in this program. Applicant signature Date Please mail or hand-deliver completed applications to either of the following locations: Iowa City Police Department: 410 East Washington Street, Iowa City, IA 52240 North Liberty Police Department: 340 North Main Street, North Liberty, IA 52317 University of Iowa Police Department: 200 South Capitol Street, Suite 808, Iowa City, IA 52242 Applications must be received by 5pm on March 11th, 2022 to be considered for the 2022 series. Behind the Badge 2022 Series Participant Instructions Johnson County Community Police Academy sponsored event Behind the Badge Media Waiver I, ____________________________________ (participant name) have been accepted to attend the 2022 Behind the Badge series. To promote future participation in the Behind the Badge series, local media may be on site taking photos, videos, and interviewing participants throughout the length of the series. Please check the appropriate box below and sign/date. YES, I agree to the use of my photo/video/interview for current or future use (circle all that apply) NO, I do not want to be photographed, videoed, or interviewed (circle all that apply) _________________________________________________________________________________ Signature Date PLEASE RETURN SIGNED FORMS WITH YOUR APPLICATION.