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Sheriff's Office Program Application

  1. Footer ID

  2. Personal Information

  3. Sex*

  4. Authority to Conduct Background Check*

    By placing my electronic signature below, I hereby authorize the Louisa County Sheriff’s Office to examine the records available to the Louisa County Sheriff's Office in connection with my application for this community outreach program (CLEA, LEAP, JCLEA, TDC). I hereby authorize the release of any information that the Louisa County Sheriff’s Office may request. A copy of this release shall be as valid as the original document. I also understand and agree that all information received by the Louisa County Sheriff’s Office in connection with my application and background is confidential and may be disclosed to me.

  5. List any past volunteer experience you may have.

  6. Instructions

    Applicants should not assume they have been selected until they have received confirmation from one of the Program Coordinators. More information will be provided at that time. If you have medical conditions/previous injuries and/or Medications please contact one of the Program Coordinators prior to filling out application.

  7. Shirt Size*

  8. Applicant's Electronic Signature Agreement*

    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.

  9. If under 18 Parent / Guardian Electronic Signature Agreement

    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.

  10. Leave This Blank:

  11. This field is not part of the form submission.