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Citizens Academy Application Form

Steps

  1. 1. Waiver of Liability & Release Form
  2. 2. Applicant Information
  • Waiver of Liability & Release Form

    1. MPD BadgeMPD Seal

      Maui Police Department

      Citizens Police Academy Application
      Program INSPIRE

      Information provided is confidential and for MPD use only.

    2. APPLICANT'S WAIVER OF LIABILITY AND RELEASE FORM


      In order to permit the Maul Police Department, hereafter referred to as the "Department", to make a thorough investigation of my personal and work experience background, personal habits, and reputation, for the purpose of determining my fitness and suitability for employment with the Department:

    3. I, ____

    4. consent to and give the Maui Police Department (the “Department”) permission to conduct a pre-employment background check that may require the Department to obtain private personal information.  I understand that the background check may include an employment background investigation, criminal history background investigation, and a credit check that will help the Department determine my responsibility, integrity and ability towards meeting and fulfilling financial obligations

      I consent to and give the Department permission to investigate my personal reputation and work background and qualifications. I authorize any person or legal entity who may be contacted by Department or its agents to release and transmit to the Department any of my personnel files or other information, data, or opinions about my prior employment or suitability for employment with the Department.  I hereby waive any rights to privacy or confidentiality that may prevent any former employer from providing the Department with this information.

      I authorize the Department to access my credit report for employment purposes.  I further authorize the Department to reproduce this form to be used for the purpose of conducting the pre-employment investigation.

      I am aware that the work of the Department is inherently dangerous.  Participation in the Citizens Police Academy includes potentially dangerous activities that could subject me to death or personal injury or damage to my personal property.  I do freely, voluntarily and with such knowledge assume the risk of death, personal injury, or property damage arising from or in any way connected with the use of weapons, motor vehicles, unlawful acts of forcible resistance by law violators or suspected law violators, while accompanying or under the guidance of Department officers or their agents. 

      I agree for myself and my legal representatives, heirs, and assigns to release and discharge the County of Maui and the Department, its officers, agents and employees, from any liability for any loss or damage or any claim or damages resulting from my participation in the Citizens Police Academy.  I further agrees to hold harmless and release from liability the County and the Department, its officers, its employees, and its agents, for any statements, acts, or omissions in the course of its investigation into my personal and work experience background, personal habits and reputation.

    5. By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.
    6. I agree*
    7. .