Upcoming Session(s): (Select One)	March 9th -May 4th Afternoon 1-4pm March 9th -May 4th Evening 6-9pm
	Main Training Room (EOC) - 18900 Cortez Boulevard
	Atria - 7030 Evergreen Woods Trail, Spring Hill
Full Legal Name:
Any Other Names you have been known by:
Address:
City / State / Zip:
Telephone Number:
Email Address:
Social Security Number:
Gender:	Select Male Female
Driver's License Number:
Drivers License State:
Drivers License Exp:
Have you ever been arrested?	Select Yes No
If YES, list the charges and disposition:
Date of Birth:
Comments:
If you have any specific questions that are not addressed on this form or experiencing issues submitting this form, please contact Amber McClanahan, Community Relations Coordinator 352-797-3680.

By clicking submit you certify that: 1. The information supplied in this application is true and correct to the best of your knowledge. 2. You grant the Hernando County Sheriff's Office permission to verify all information provided. 3. You are aware that a criminal history will be conducted by the Hernando County Sheriff's Office. 4. A denial of this application may occur if any false statements or misrepresentation of any facts are noted in the process. 5. If any blanks appear on the application it will not be considered.