CHIEF’S COMMUNITY IMPACT TEAM APPLICATION

TAMPA POLICE DEPARTMENT
CHIEF’S COMMUNITY IMPACT TEAM
APPLICATION

The Tampa Police Department is seeking engaged City of Tampa residents to serve on the Chief’s Community Impact Team.

Applicants for the Team must have lived in the City of Tampa for the previous five (5) years; be active in the community; and be available to individually meet as needed with the Chief. Team members will be selected and appointed by the Chief of Police with the goal of establishing a diverse group of Tampa residents who are willing to share information with the Chief about police department matters which positively or negatively impact the communities they live in. Answering “Yes” to any of the below questions will not disqualify you as an applicant.

First Name

Last Name

Date of Birth

Race

Sex

Address

City/Town

State/Province

ZIP/Postal Code

Length of time at this address: Years

Months

Name of Neighborhood (if known)

Number of years you have lived in the City of Tampa

Phone number

Driver license number

Occupation

Business name

Number of years you have worked for this business

Business address

City/Town

State/Province

ZIP/Postal Code

Have you ever been arrested by the Tampa Police Department?

Yes

Have you ever been convicted of, or had adjudication withheld for a felony?

Yes

Have you or anyone you know ever sued or filed a claim against the City of Tampa, or the Tampa Police Department, or its Officers?

Yes

Have you ever filed an internal affairs complaint against an Officer?

Yes

Describe your community involvement (volunteer work / civic associations / groups / organizations)

Please briefly state why you wish to serve on the team

Please provide the name and contact information for one person who can recommend you for the team

First Name

Last Name

Referral Phone number

Referral Email

By submitting this application, you are affirming that the above is true and correct and you consent to a background check.

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CHIEF’S COMMUNITY IMPACT TEAM APPLICATION

TAMPA POLICE DEPARTMENT CHIEF’S COMMUNITY IMPACT TEAM APPLICATION

TAMPA POLICE DEPARTMENT
CHIEF’S COMMUNITY IMPACT TEAM
APPLICATION