Police Chief's Citizen Advisory Board
Name
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email
example@example.com
Home Phone Number
-
Area Code
Phone Number
Other Phone Number
-
Area Code
Phone Number
Place of Employment
Occupation
Do you reside in the City Limits?
Yes
No
Why are you interested in serving on the Chief's Advisory Board?
Tell us about your interest, skills, education, areas of expertise and professional organizations that you feel would be of assistance as a member of the CAB
Has any formal charge of professional misconduct ever been sustained against you in any jurisdiction?
Yes
No
If yes, please explain complete disposition:
Is there any possible conflict of interest or other matter that would create problems or prevent you from fairly and impartially discharging your duties as a member of the CAB?
Yes
No
If yes, please explain conflict:
Please verify that you are human
*
Submit
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