Home Citizens Academy Application - Las Vegas, Reno Resident Agency

Citizens Academy Application - Las Vegas, Reno Resident Agency

FBI Citizens Academy Application
FBI Las Vegas, Reno Resident Agency — 2018

Fields marked in red are mandatory. If not applicable or if you choose not to answer, you must enter N/A. Providing the requested information is voluntary; however, failure to provide the requested information—except for optional race and national origin information—may result in you not being selected to attend the FBI Citizens Academy.

This form will be used by the FBI in determining whether you meet the criteria for the FBI Citizens Academy program. The final determination of whether you meet the criteria for the FBI Citizens Academy program is the responsibility of the FBI. The FBI does not discriminate on the basis of race, color, religion, sex, national origin, disability, or sexual orientation when granting access to the FBI Citizens Academy program.

Personal Information
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Gender:  



Driver's License Information
U.S. Citizenship:  




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Address/Contact Information
In the event of an emergency, list a relative or close associate who can be contacted:
Employment Information
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Organization Memberships
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Criminal Background Information
1. Have you ever been charged with or convicted of any felony offense?  


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2. Have you ever been charged with or convicted of a firearms or explosives offense?  


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3. Are there currently any charges pending against you for any criminal offense?  


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4. In the last 10 years, have you been arrested for, charged with, or convicted for any offense?  


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Ethnicity and Race Identification (Optional)

The information collected in this section will be used only to focus outreach efforts to improve the diversity of the Citizens Academy program. Providing this information is voluntary, and failure to do so will have no effect on the determination of whether you meet the criteria for the FBI Citizens Academy program.

These questions are designed to identify your ethnicity and race. Regardless of your answer to question 1, please also answer question 2.

NOTE: The racial categories in question 2 are defined as follows:

  • American Indian or Alaska Native: A person having origins in any of the original peoples of North and South America (including Central America) and who maintains tribal affiliation or community attachment.
  • Asian: A person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian subcontinent (e.g., Cambodia, China, India, Japan, Korea, Malaysia, the Philippine Islands, Thailand, and Vietnam).
  • Black or African-American: A person having origins in any of the black racial groups of Africa.
  • Native Hawaiian or Other Pacific Islander: A person having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands.
  • White: A person having origins in any of the original peoples of Europe, the Middle East, or North Africa.
1. Are You Hispanic or Latino? A person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin, regardless of race.


2. Select the racial category or categories with which you most closely identify. See descriptions above. Check all that apply.
Participation in Firearms Demonstration
Is there any reason you cannot participate in a firearms demonstration?  


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Nomination Information
Nominated as a potential candidate for participation in the FBI Citizens Academy program by:  



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Certification and Authorization to Conduct Law Enforcement Checks

I hereby authorize the FBI to conduct a standard check of law enforcement records on me. I understand this check will include, but not be limited to, any record of charges, prosecutions, or convictions for criminal or civil offenses. This check will be used for the purpose of the FBI's Citizens Academy program application process. My consent is valid for three months from the date authorized below. Any information obtained will be used for the purpose of providing clearance to participate in the FBI's Citizens Academy Program.
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By typing my name and providing a date on this form, I certify that I am the individual applying to the FBI Citizens Academy whose information appears on this form and that I authorize the FBI to conduct the law enforcement checks described above. I further certify that the information I have provided is true, complete, and correct to the best of my knowledge and that I am aware that knowingly and willfully concealing a material fact or making a materially false, fictitious, or fraudulent statement may violate Title 18 of the United States Code, Section 1001.


Date:
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Privacy Act Statement

The collection of information on this form is authorized by Title 28, United States Code, section 533; Title 28, Code of Federal Regulations, section 0.85; and Department of Justice Order 2600.2D, Security Programs and Responsibilities (June 16, 2011). Your Social Security number is requested as authorized by Executive Order 9397 (Nov. 30, 1943), as amended by E.O. 13478 (Nov. 18, 2008). The information is collected to assist the FBI in evaluating your application for the Citizens Academy program and to maintain the security of FBI personnel, facilities, and information systems, except for the optional information regarding race and national origin, which will only be used to focus outreach efforts in order to improve the diversity of the program. Providing the requested information is voluntary; however, failure to provide the requested information—except for optional race and national origin information—may result in you not being selected to attend the FBI Citizens Academy. The information you provide will be maintained in the FBI’s Central Records System (Justice/FBI-002), notice of which was published in the Federal Register and may be viewed at https://www.fbi.gov/services/records-management/foipa/fbi-privacy-act-systems. The information you provide may be used in accordance with the routine uses contained in that notice or as otherwise authorized by law.


Notice

Knowingly falsifying or concealing information required on this form will result in your application being rejected. In addition, Title 18 Section 1001 of the U.S. Code provides that knowingly falsifying or concealing a material fact may under certain circumstances constitute a felony resulting in fines and/or imprisonment.


For questions, please contact FBI Community Outreach Specialist Tina M. Roskos at (702) 584-5574 or Tina.Roskos@ic.fbi.gov at:

FBI Las Vegas
Attn: Community Outreach Specialist Tina M. Roskos
1787 W. Lake Mead Blvd.
Las Vegas, NV 89106

 

Deadline for Applications: August 31, 2018