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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 Chief Dan O’Neil at doneil@auburnwa.gov or Commander Cristian Adams at cadams@auburnwa.gov.

Applicant's Name

Residence Address

Mailing Address

EMPLOYMENT HISTORY

Address

Address

REFERENCES

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

Personal Reference

Professional Reference

BACKGROUND INFORMATION

What position are you applying to represent?

AUTHORIZATION FOR BACKGROUND AND REFERENCE CHECKS

Date of Birth

Sex

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

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?

Signature of Applicant

Choose how to sign

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):

Veteran Status

Disability Status