Mercer Island Police IFIT-KC Non-Law Enforcement Community Representative Application

Forms and applications may be subject to disclosure pursuant to the Washington State Public Records Act (chapter 42.56 RCW).

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Applicants Legal Name: (required) *

Address: (required) *

Occupation:

Home Phone Number:

Cell Phone Number:

Email Address: (required) *

Date of Birth:

A date of birth is required to complete a background check. If you would prefer not to submit your date of birth with your form, please call 206-275-7911 to provide this information.

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Attestation: (required) *

I certify and declare, under penalty of perjury under the laws of the State of Washington that the foregoing is true and correct.

How did you hear about the IFIT Community Representative position?

Please tell us why you are interested in this position?

Please list any community groups or affiliations.

Upload Letter of Interest: (required) *

Files must be less than 2 MB.
Allowed file types: pdf doc docx.

Upload Resume: (required) *

Files must be less than 2 MB.
Allowed file types: pdf doc docx.

Sign: (required) *

As an applicant for the Mercer Island Police Department IFIT-KC Non-Law Enforcement Community representative, I hereby authorize the Mercer Island Police Department to conduct a criminal history records check. I understand that this criminal history check is being conducted due to the nature of the position, and that the information will be used in determining eligibility for all applicants. All information will remain confidential as required by Washington and federal statutes.

Date Signed:

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