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? *

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? *

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: *

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

If appointed, I will attend regularly scheduled meetings. *

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. *

Legal Name: *

Gender: *

Female
Male
Non-binary
Prefer Not to Answer

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

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

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

If yes, what language(s)?

Current Occupation and Employer: *

Are you a current law enforcement officer? *

Are you a former law enforcement officer? *

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

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? *

Do you have charges pending in any court? *

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. *

LIBERAL LEAVE IS IN EFFECT FOR WASHINGTON COUNTY GOVERNMENT

Liberal leave is in effect for all non-essential personal on Tuesday, February 13, 2024, until noon. Essential personnel are expected to fulfill their duties as usual.

The starting time for today’s Board of County Commissioners meeting will be reevaluated at 9:00 am.

For those required to travel, exercise caution on the roadways. If driving is necessary, ensure your vehicle is completely cleared, drive at a reduced speed, practice caution, and avoid crowding or passing plows.

We’ll keep the public informed of any changes. Stay updated by monitoring Washington County Government’s website and social media channels for the latest information. Your safety is our priority!

Application for Civilian Appointment to the Trial Board

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

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LIBERAL LEAVE IS IN EFFECT FOR WASHINGTON COUNTY GOVERNMENT