Clay County Sheriff Office

Citizens' Academy Application

Please fill out this form.
Then Submit it by clicking on the Submit Button

Contact Information

First Name: *

Last Name: *

Street Address: *

City: *

Zip Code: *

Telephone Number: *

Personal E-mail: *

Employer Information

Empolyer: *

Employer Address: *

Work Number: *

Personal Information

Date of Birth: *

Place of Birth: *

Sex:
*

Race:
*

Height:
*

Weight:
*

Hair:
*

Eyes:
*

Driver's License Number:
*

Social Security Number:
*

Have you ever been arrested?*
Yes No

If Yes, Please explain the details below:

* Required Fields

Home • About • Clay • Services & Programs • Sector Map • Speak • News • Careers • Business • Learn • Contact