[City of Auburn] Police Advisory Committee Application

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Application For Auburn Police Advisory Committee

Thank you for your interest in the Auburn Police Department's Police Advisory Committee! Please provide us information about yourself that will help us evaluate individuals to serve on the APAC to ensure that we can assemble a diverse cross-section of our community to help us better serve Auburn in the most just and equitable way.

NOTE:

Leaving a question blank will not automatically disqualify you as an applicant. If you prefer not to provide an answer simply state "Prefer not to answer" or “N/A” in the space provided.
A criminal background check will be required of each applicant, however, having a criminal record will not be an automatic disqualifier. Offenses that may disqualify an applicant could be, but are not limited to, a violent offense, sex offense, or related to a charge or conviction for domestic violence.
A social security number is not required to apply, but may be needed in order to verify identity in the case of common names. If we need more information we will contact you privately.

If you have any questions or concerns please contact Commander Cristian Adams at cadams@auburnwa.gov.

Home Phone

Cell Phone

How long have you been a continuous resident of the City of Auburn?

Have you ever used or been known by any other name?

EMPLOYMENT HISTORY

Present or Last Employer

Position

Dates

Phone Number

Previous Employer

Position

Dates

Phone Number

REFERENCES

The following individuals are qualified to comment on my capabilities. Please identify one personal and one professional reference.

Personal Reference

Name *

Relationship *

Phone Number

Professional Reference

Name *

Relationship *

Phone Number

BACKGROUND INFORMATION

Describe your civic involvement in the Auburn community:

Describe why you are interested in serving on this Committee:

Describe how your specific experience makes you qualified for this particular Committee:

AUTHORIZATION FOR BACKGROUND AND REFERENCE CHECKS

Social Security Number

Sex

Female

Male

Driver’s License Number:

Issuing State

Have you lived in any other State(s) other than Washington in the last ten (10) years?

Yes

If YES, please note the State(s), County(ies) and dates of residence:

I certify that I have read and understand all questions and statements contained in this application, further, that all statements I have made herein are true and correct to the best of my knowledge and belief.

I understand that if selected for a position to serve on this Committee, that I will be required to attend a majority of the meetings held.

I understand that applications are subject to the Washington State Public Records Act.

I understand this application authorizes a reference check and hereby authorize any individual, company, or institution with whom I have been associated to furnish the City of Auburn any pertinent information concerning my employability which they may have on record or otherwise. I do hereby release the individual, company, or institution and all individuals connected therewith from all liability for any damages whatsoever incurred in furnishing such information.

I hereby authorize the City of Auburn or an independent investigating agency appointed by the City to conduct a thorough investigation of my background including my criminal records, driving records (as applicable), credit history (as applicable), educational history (as applicable) and employment references (as applicable). I also hereby release any current or former employers or institutions, their agents or employees from any and all liability resulting from the release of such information. My authorization and release from liability are voluntary acts. This authorization shall be effective for employment and/or volunteer opportunities with the City of Auburn only.

It is my intention that any copy of this authorization be as effective as is the original.

NOTE: Information contrary to State laws against discrimination is not sought or utilized.

Do you agree to the above statements?

I agree

Signature of Applicant

First Name

Last Name

Choose how to sign

Draw Type

I agree to electronically sign and to create a legally binding contract between the other party and myself, or the entity I am authorized to represent.

EQUAL EMPLOYMENT OPPORTUNITY INFORMATION

(This information is voluntary and in no way affects the outcome of your application.)

Ethnic Origin (please select one of the following):

Hispanic / Latino (Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin regardless of race)

White / Caucasian (having origins in any of the original peoples of Europe, the Middle East, or North Africa)

Black / African American (having origins in any of the black racial groups of Africa)

Native Hawaiian / Other Pacific Islander (having origins in any of the peoples of Hawaii, Guam, Samoa, or other Pacific Islands)

Asian American (having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian Subcontinent, including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam)

American Indian / Alaska Native (having origins in any of the original peoples of America, and who maintain tribal affiliation or community attachment)

Two or More Races (all persons who identify with more than one of the above)

Veteran Status

Not a veteran

Disabled veteran

Vietnam-era veteran

Any other veteran

Disability Status

Disabled

Non-Disabled