PITTSBURGH BUREAU OF POLICE POLICE OFFICER CANDIDATE ORAL BOARD INTERVIEW PANEL APPLICATION The position for which you are applying is a voluntary, unpaid position. Name: Last
First
Middle
City
PA State
Address: Street Address
Zip
Neighborhood in Which You Live: E-Mail Address: Telephone: Home
Work/Other
Date of Birth: Social Security #: Sex:
Race:
Highest Level of Education Completed: Occupation:
Employer:
Organizations of Which You Are A Member (civic clubs, community organizations, block watch, etc.): Please Tell Us Why You are Interested In Participating in the Oral Interview Process: Interviews are scheduled for July 21-July 30, 2015 at Greenway Middle School (located in the City’s neighborhood of Sheraden). You must be available for training prior to the start of the interviews. Are you available from 8:00 a.m.-4:00 p.m. on Monday, July 20, 2015 for training? Yes No You must be available at least 2 full days (7:30 a.m. - 4:00 p.m.) during the two week period for the scheduled interviews. Are you available for at least 2 full days? Yes No You must be willing to sign a confidentiality agreement regarding the process and materials. Are you willing to sign the agreement? Yes No You may attach a resume to this application. Is there a resume attached? Yes No
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For consideration to sit on an oral board interview panel, you must be free of criminal convictions of a Misdemeanor 2 level or higher. Have You Ever Been Convicted of a Crime graded as Misdemeanor 2 or 3 or a Felony (any grade) ? Yes No
If yes, explain: I give my permission to the Pittsburgh Department of Public Safety, Bureau of Police, to conduct a background check to determine if I have a criminal record.
Signature _________________________________
Date: ________________________
AUTHORIZATION FOR RELEASE OF INFORMATION I, ____________________________ DO HEREBY AUTHORIZE any and all persons, employers, Partnerships, corporations, and all civilian and government entities, military agencies, law enforcement agencies, private, City, County, State and Federal entities to release, furnish and exchange any and all available information relating to me for the purpose of determining my suitability to be appointed as a member of the Police Officer Candidate Oral Board Panel. This includes, but is not limited to, all information related to my character, integrity, reputation, conduct and behavior, and criminal background. This authorizes release to the Pittsburgh Bureau of Police.
This release is in addition to, and intended to curtail or diminish, the authorization and immunity provided by statute. I DO HEREBY RELEASE from any and all liability, all persons or entities disclosing information pursuant to this release.
Signature of Applicant:______________________________ Date: _____________
Signature of Witness: ________________________________ Date: _____________
Please return all pages of the application to: PITTSBURGH BUREAU OF POLICE OFFICE OF PROFESSIONAL STANDARDS ATTN: COMMANDER JENNIFER FORD 1203 WESTERN AVENUE PITTSBURGH, PA 15233
email: jennifer.ford@pittsburghpa.gov fax: (412) 231-2153 phone: (412) 323-7123 2