Submit a request – Human Resources

Please select a form to submit your request

Your email address

Subject

Please provide a very brief description of what you are requesting.

Description

Please provide specific details for your request here. You may attach documents/files that will be helpful for us to complete your request (i.e. images, text, supporting documentation, etc.) at the bottom of this form.

Please indicate which board(s) you are applying to serve on.

You may select more than one.

Last Name

Please enter your last name.

First Name

Please enter your first name.

Middle Initial

Nickname(optional)

If you are known by a nickname, please enter it here.

Mailing Address

Mailing Address City

Mailing Address State

Mailing Address Zip Code

Is your home/street address different from your mailing address?

Home Address (No PO Box)(optional)

Please enter your home/street address - No PO Boxes please.

Home City(optional)

Please provide the city for your home/street address.

Home State(optional)

Please provide the state for your home/street address.

Home Zip Code(optional)

Please provide the zip code for your home/street address.

How many years have you lived at your current address?

Home Phone Number

If you do not have a home phone number, please enter N/A.

Cell Phone Number

If you do not have a cell phone number, please enter N/A.

Work Phone Number(optional)

If you do not have a work phone number, please enter N/A. Please don't forget to include your phone extension, if applicable.

Please select your registered voter district from the drop down list.

Please explain your experience that would be of benefit to have you as a member of the PAB and/or CCACC.

Please explain your interest in serving on the PAB and/or CCACC.

Please explain your education or work history as it applies to serving on the PAB and/or CCACC.

Are you currently serving on other Boards, Commissions or Committees?

If appointed, I will be able to attend regularly scheduled meetings.

If appointed, I authorize the release of my contact information to the press or public, if requested.

I understand appointees to this board/committee are required to comply with the Code of Ethics 41.15.B.2 regarding financial disclosure for any potential conflict of interest upon appointment, completion of term, annually, and/or termination.

Legal Name

Please enter your name as it appears on your driver's license or state-issued identification card.

Sex

Please choose from the drop down.

Race

Please enter your race.

Do you identify as a member of a minority population within Calvert County?

Which minority do you identify as?

You may list more than one minority group.

Can you comprehend spoken English and speak English, comprehend written English, read and write English?

Occupation(optional)

Please explain your occupation for purposes of determining relevancy to membership on this board.

Are you a current or former law enforcement officer?

Please note: correctional officers are considered law enforcement officers.

What agencies?

Please enter the law enforcement agency or agencies you were employed by.

Please provide the number of years served at the agencies listed above.

Please provide the highest rank you achieved in law enforcement and the number of years served at that rank.

Were you honorably discharged?

If retired or former law enforcement, what year did you retire or leave law enforcement?

If this question doesn't apply, please enter N/A. An entry in this field is required to submit the application.

Do you have an immediate family member who is a current or former law enforcement officer? An immediate family member is defined as parent, sibling, spouse or child.

Please note: correctional officers are considered law enforcement officers.

Please provide their names and their relationship to you.

What agencies?

Please enter the law enforcement agency or agencies your immediate family member(s) were employed by.

Please provide the number of years they served at each of the agencies listed above.

Please provide the highest rank your immediate family member(s) achieved in law enforcement and the number of years served at that rank.

Were they honorably discharged?

If retired or former law enforcement, what year did they retire or leave law enforcement?

If this question doesn't apply, please enter N/A. An entry in this field is required to submit the application.

Are you interesting in serving as Chair of the Police Accountability Board?

Please describe your relevant experience for serving as the Police Accountability Board Chair.

Have you been convicted of any crime, other than a minor traffic violation, that is a payable offense?

Have you been convicted of a crime punishable by imprisonment exceeding one year and received a sentence of imprisonment for more than one year?

Were you pardoned?

Please provide the date of your pardon.

Please provide the authority granting the pardon.

Do you have a charge(s) pending in a federal or state court for a crime punishable by imprisonment exceeding one year?

Resume Attached?(optional)

You are required to submit a resume' along with your application. Please use the attachments field at the bottom of this application to attach your resume' by clicking on "Add file" and, once attached, check this box.

By checking this box and typing your name below, you are certifying the information provided in this application is correct and complete.

Please print your first and last name in this field to certify the information in this application is correct and complete.

Please enter today's date.

Attachments(optional)

Add file or drop files here