650 W. State Street 815-319-6000

Cadet's Application Form

Personal Information

Answer all questions accurately and completely. Any false statement will disqualify you from this program. Any question that does not apply use N/A

First Name

Middle Name

Last Name

Address

City

State

Zip

Phone Number

Cell Phone Number

Email Address

Age

Birthdate

Place of Birth

Name and Address of School

Highest Grade Completed

Adult Shirt Size

Employer #1 Information

If applicable, list below the last two jobs you have held, beginning with your present or most recent job.

Name of Business

Telephone Number

Employer Address

May we contact the employer?

Yes

Exact Title or Position Held

Employed Date Rage

Name and Title of your Direct Supervisor

Reason for Leaving

Employer #2 Information

Name of Business

Telephone Number

Employer Address

May we contact the employer?

Yes

Exact Title or Position Held

Employed Date Rage

Name and Title of your Direct Supervisor

Reason for Leaving

Driving History

List all traffic violations you have received. Include the police agency, violation, disposition, and year of violation

Has your driver's license ever been suspended or revoked?

Yes

If yes, please explain why and when

Criminal History

Have you ever been arrested?

Yes

If yes, state the nature of the offence(s) and its disposition

References #1

Name

Address

Phone Number

Relation

References #2

Name

Address

Phone Number

Relation

References #3

Name

Address

Phone Number

Relation

Parental Information

If you are under 18, the below information is for your parent or guardian giving you permission to join Winnebago County Public Safety Cadets.

Parent or Guardian's name

Child's Name

Authorization For Criminal Background Investigation

AUTHORIZATION FOR CRIMINAL BACKGROUND INVESTIGATION
I authorize and empower the County of Winnebago, Winnebago County Sheriff's Department, or other outside service company engaged by the County of Winnebago for the purposes of performing a background investigation, to obtain, prepare, use, and furnish information.

Full Name

Street Address

Date of Birth

City

State

Phone

Medical Release Form

I hereby give my consent to a licensed medical provider to administer necessary treatment to my son/daughter in the event of an emergency when I cannot be reached. I also give my consent to the transportation of my son/daughter by ambulance if warranted.

Parent/Guardian Name

Child's Name

Name of Physician

Physician's Phone Number

Physician's Address

Allergies of son/daughter, including any allergies to medication:

Date of last tetnus

Phone Numbers which parents/guardian can be reached in case of an emergency:

Emergency Contact #1 Name

Emergency Contact #1 Number

Emergency Contact #2 Name

Emergency Contact #2 Number

Photo Release Form For Adults

I hereby grant permission to the County of Winnebago and the Winnebago County Sheriff's Department to use my photographic and/or video graphic likeness in print or in online materials designed for news, information or educational purposes related to the Winnebago County Sheriff's Police Public Safety Cadet program.

Name

Address

Phone

Photo Release Form For a Minor

I hereby grant permission to the County of Winnebago and the Winnebago County Sheriff's Department to use my minor child's photographic and/or video graphic likeness in print or in online materials designed for news, information or educational purposes related to the Winnebago County Sheriff's Police Public Safety Cadet program.

Explorer's Name

Parent/Guardian's Name

Address

Phone

Cadet Physical Agility Test Waiver

I, hereby agree that by signing this document, I consent to waive (child/guardian) legal rights, including the right to sue the following party, and if applicable, its representatives and facilities from any physical, material, tangible, or intangible loss or damages that may happen to me during my participation in any of the physical fitness testing process. I will be participating in the Physical Agility Test that will be conducted by the Winnebago County Sheriffs Police that will include, but not limited to the following; Strength, Metabolic, Conditioning, Flexibility, Etc. It is my responsibility to consult a Physician before participating in the Physical Agility Test and I affirm that I have no medical conditions that would restrict me from participating in any of the testing process.

Participant's Name

Participant/Guardian if under 18

Public Safety Cadets Uniform Requirements

Public Safety Cadets Uniform Requirements

Provided by the Unit: (2) Gray Polo shirts with PSC

Provided by cadet

Navy tactical pants
Black boots/shoes (must be ALL black)
Black belt

Uniform
Gray polo, navy blue tactical pants, black belt, black boots/shoes

Make sure this uniform is wrinkle free and clean at all times. Shirt shall be tucked in at all times. You are representing yourself and the department, take pride in your uniform.

If you are a ranking member, meaning Sergeant and above, your pins will be placed on both sides of the collar of your polo. These will be provided for you, however if you lose one it is your responsibility to replace them.

At no point will you wear the uniform when you are not engaged in a Cadet function.

At no point will you have a weapon on you while in uniform. This includes, but is not limited to: firearms, knives, pepper spray, baton, anything else deemed a weapon by an advisor.

If you need recommendations for where to get any of these items, please let us know and we will send you links to them.

Public Safety Cadet Terms

Public Safety Cadet Terms

When I satisfy the requirements for becoming a Cadet, the sheriff's department will provide me with two uniform shirts and an ID card, at no cost to me. I will be responsible for paying the $20 membership fee.
I understand that the uniform shirts and ID card are the property of the Winnebago County Sheriff's Department Public Safety Cadets Unit. A separate uniform and ID card sign out sheet will be provided.
It will be my responsibility to clean and maintain the uniform.
I will not use the uniform or ID Card for any purpose other than those purposes expressly authorized by the sheriff's department.
I will report any damage to the uniform or ID card to a mentor at my earliest convenience, relating the damage incurred and the circumstances causing the damage.
I agree to return the uniform or ID card to a mentor at the request of the sheriff's department.
I hereby consent to provide my date of birth for the purpose of a background check.
I hereby consent to the release of my minor child's academic records and authorize the Winnebago County Sheriff's Department to contact my minor child's school as part of the background check.
I understand that I must obtain transportation to, and attend, Cadet meetings and functions.
I understand that I will be required to participate in basic physical fitness test, to include a 1.5-mile run, sit and reach test, sit up test, and a bench press test. This is not a pass/fail test, rather it mimics the basic POWER Test required for all Illinois Police Officers.
I agree to participate in a brief interview.
I have read and understood the above terms and my signature below indicates that I am in agreement to these terms.

Cadet's Application Form

Personal Information

Employer #1 Information

Employer #2 Information

Driving History

Criminal History

References #1

References #2

References #3

Parental Information

Authorization For Criminal Background Investigation

Medical Release Form

Photo Release Form For Adults

Photo Release Form For a Minor

Cadet Physical Agility Test Waiver

Public Safety Cadets Uniform Requirements

Public Safety Cadet Terms

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