Application for Civilian Appointment to the Trial Board

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Application for Civilian Appointment to the Trial Board

Email: *

Name: *

First

Middle

Last

Preferred Name: *

Residence Address: *

Address Line 1

City

State

Zip Code

Is your Residence Address different from your Mailing Address? *

Yes
No

If yes, what is your Mailing Address?

Home Phone Number:

Mobile Phone Number:

Work Phone Number:

Date of Birth: *

Are you a registered voter of Washington County? *

Yes
No

If you are a registered voter of Washington County, when did you become a resident of Washington County?

Please choose one or more relevant fields of education/experience(s) that you have: *

Behavioral Health Field
Community Service Organization
Criminal Justice System
Human Resources or Personnel Management
Law Enforcement Organization
Legal Field
Operation of a Government Agency
Social Services
Relevant Lived Experience

Please provide details of your relevant education and/or work experience indicated above. *

If appointed, I will attend regularly scheduled meetings. *

Yes
No

I understand appointees to the Civilian Trial Board are required to comply with the Washington County, Maryland, Ethics Ordinance No. ORD-2011-20. The Ordinance may be accessed here: https://www.washco-md.net/wp-content/uploads/ORD-2011-20-1.pdf. *

Yes
No

Legal Name: *

Gender: *

Female
Male
Non-binary
Prefer Not to Answer

Race: *

American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or Other Pacific Islander
White
Other

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

Yes
No

Are you fluent in speaking, reading, and writing English? *

Yes
No

Are you fluent in speaking, reading, and/or writing any language other than English? *

Yes
No

If yes, what language(s)?

Current Occupation and Employer: *

Are you a current law enforcement officer? *

Yes
No

Are you a former law enforcement officer? *

Yes
No

Is a member of your immediate family a current or former law enforcement officer? *

Yes
No

If yes, please identify the family member and agency.

Have you been convicted of, or received a probation before judgment for, a felony or a misdemeanor with a statutory penalty of any amount of time? *

Yes
No

Do you have charges pending in any court? *

Yes
No

If yes, where? Please enter the court name and state.

Please provide any additional information that you would like the search committee to consider.

Attach Cover Letter and Resume (optional).

Click or drag files to this area to upload. You can upload up to 2 files.

Max file size 25mb

By checking this box and entering your name below, you are certifying the following:

1. The information provided in this application is correct and complete. 2. You understand that you are subject to a criminal history background check prior to appointment and agree to provide your full Social Security Number and fingerprints if you are selected to move forward in the appointment process. 3. You authorize agents of the Board of County Commissioners of Washington County, Maryland, to conduct a criminal history background check on you to the extent necessary to determine your eligibility to serve on the Civilian Trial Board.

Check this box if you certify the above

Please enter your first and last name in this field. *

Please enter today’s date. *

About Washington County, MD

100 West Washington Street Hagerstown, MD 21740
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(240) 313-2776
Office Hours: Monday-Friday, 7:30 a.m. – 4:30 p.m.
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