APPLICATION FOR BOARD APPOINTMENT TO THE COMMUNITY POLICE
(PLEASE PRINT OR TYPE)
Home Address, Phone Number
Occupation, Place of Employment
Home Phone Work/Cell Phone ___________________
Number of Years in SpringfieldSpringfield Resident? ________ _______
Registered Clark County Voter? __________
Are you related to any current City Official / Employee?
If so, state name and relationship
Have you served on any City Board(s) / Committee(s) previously? If so, please list with
Have you been through the Springfield Police Division Citizens Police Academy? _____________
If not, are you willing to attend the Citizens Police Academy during the first two years of your
PLEASE ATTACH THE FOLLOWING:
* A brief summary of your formal education, work experience, organization memberships,
areas of interest or expertise, and community service.
* A brief statement explaining your experiences and commitments to diversity. The City is
very committed to inclusivity and supporting our diverse population. This statement may
include: 1) Your values related to diversity; 2) Your experiences working with diverse
populations and; 3) Your future plans related to inclusivity.
APPLICANT'S SIGNATURE DATE
APPLICATIONS MAY BE DELIVERED, MAILED, E-MAILED OR FAXED TO:
Clerk of the City Commission
City of Springfield
76 East High Street
Springfield, Ohio 45502
firstname.lastname@example.org * (937) 324-7341 * FAX: (937) 328-3497
THANK YOU FOR YOUR INTEREST IN THE CITY OF SPRINGFIELD!
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