Fillable Citizens Advisory Panel Membership Application (City of Hood River)

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Citizens Advisory Panel Membership Application (City of Hood River)

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Hood River Police Department Police and Community Relations Team
Membership Application
The purpose of this application is to obtain general information concerning the background and qualifications of
persons desiring to be appointed as members of the Hood River Police Department’s Police and Community
Relations Team. (See information at the bottom of the back page of this application). Appointments are made by the
Chief of Police. Expected commitment is attendance to one meeting per month. Meeting length will usually be one
hour, but may occasionally be longer. Panel members may, at times, be privy to potentially sensitive law
enforcement information. As such, personal history information and a criminal history check is needed for all
applicants. Please answer all questions in this application. All information contained in this application will only be
used to conduct a background check, and will be strictly confidential. Use additional sheets if necessary.
Please complete and return the application to:
Hood River Police Department
Attn: Chief of Police
PO Box 27 207 Second St
Hood River, OR 97031
If you have questions about the application or the team, please call or email Chief Neal Holste at 541-387-
5256;neal_holste@ci.hood-river.or.us
Name and Date of Birth:
(Last Name, First Name, MI)
(Date of Birth [for criminal history Check])
List any other names you have used in the past, or are currently using:
_____________________________________________________________________________________________
Legal Residence:
(Street, City, State, Zip)
Residence Telephone:
Business Phone:
Occupation:
Email:
Have you ever been convicted of a crime or registered as a sex offender?
If yes, please describe:
Do you currently use illegal drugs, or have you used within the past year?__________________________________
Check as many statements below as apply to you:
□I’m a business owner or General Manager
□My business is in the Downtown Business District
□My business is in the Heights Business District
□My business is in the Westside Business District
□My business is elsewhere; Describe__________________________________
□I’m a resident of the City of Hood River
□My residential area is located (general area)____________________________
□I’m available for monthly meetings on 3rd Mondays starting at 5:30 PM
□I’d prefer a different monthly meeting day or time_______________________
I have particular interest(s) in the following issues facing the Hood River Police:
□ Traffic
□ DUII
□ Pedestrian Safety
□ Drug Crime
□ Underage Drinking
□ Property Crime
□ Identity Theft
□ Sex Crime
□ Child Abuse
□ Person Crimes
□ Home Security
□ Business Security
□ Event Security
□ Safety & Security Education
□ Special Services
□ Other ______________________________________________________________________________________
Certification and Background Authorization
I certify all information given in this application is true and complete. I authorize the Hood River Police Department
to conduct a criminal history check of me. I hereby release the City of Hood River from any liability which might be
claimed because of information obtained through such criminal history check.
Applicant Signature: __________________________________________ Date: _____________________________
Police and Community Relation Team
Constitution
The Hood River Police Department’s Police and Community Relations Team is an informal group having monthly
meetings. It is advisory only with no oversight authority. It should broadly represent the community with members
from different neighborhoods, different business districts, and other community representatives. Members must
either be residents of, or owners or managers of businesses in, the City of Hood River.
Vision
The Police and Community Relations Team is an open and objective forum offering guidance to, and collaboration
with, the Hood River Police Department in its effort to effectively deliver services in a manner that is responsive to
the community.
Mission
The mission of the Police and Community Relations Team is to positively interact with the Chief of Police to offer
community perspective on Hood River Police Department’s delivery of services.
Goals
The Police and Community Relations Team will:
1. Offer and discuss specific concerns facing neighborhoods, businesses, or the community;
2. Discuss ways the Hood River Police Department can overcome or manage various operational challenges;
3. Help the Hood River Police Department prioritize its service delivery;
4. Help mobilize the community in solving community problems as they relate to law enforcement.
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Citizens Advisory Panel Membership Application (City of Hood River)

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Completed 25 July 2020

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