Las Vegas Metropolitan Police Department (LVMPD)

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					                     Las Vegas Metropolitan Police Department (LVMPD)
                           Citizen Review Board (CRB) Application
Personal Information


Name_________________________________________SS#_____ ___ _____ Date________________
Address___________________________________________________Phone_____________________
City_____________________State_________________Apt.#___________Zip Code_______________
Mailing Address (if different) _____________________________ Date of Birth___________________

Email address:________________________________
Background Information
1. Do you reside in unincorporated Clark County or the City of Las Vegas?                               Yes____No____
2. Are you currently employed as a peace officer of LVMPD?                                              Yes____No____
3. Are you a current employee, in any capacity, of the LVMPD?                                           Yes____No____
4. Are you a former peace officer of the LVMPD?                                                         Yes____No____
5. Are you the spouse, child, sibling or parent of a current employee of LVMPD?                         Yes____No____
6. Are you the spouse, child, sibling or parent of a former peace officer of LVMPD? Yes____No____
7. Are you a former peace officer with any agency other than LVMPD?                                     Yes____No____
8. Are you a current elected official?                                                                  Yes____No____
9. Have you ever been convicted of a felony?                                                            Yes____No____
10. Have you ever been, or are you currently a party in litigation against the
    LVMPD or against the Clark County or the City of Las Vegas with regard
    to any detention facility?                                                                          Yes____No____
Please provide a brief description of your qualifications, experience or interests, which would be considered
an asset to this Review Board: attach any statements.




My resume/letter of interest is attached:                                                               Yes____No______
Where did you hear about this vacancy?____________________________________________________
I certify that the information provided is true and accurate to the best of my knowledge. (Please be advised that by signing this
document you waive privacy and confidentiality in regards to records of criminal history, employment history and such other
information as is necessary to verify your eligibility and suitability for appointment. Any member of the review board who ceases
to meet the qualifications set forth in Section 2.62.040 of the County Code shall automatically be removed from the review
board. Any member may be removed from the review board without cause or notice upon mutual agreement of the appointing
authority. This document becomes a public record once it has been received by Clark County.)




                                                                 _________________________________________
                                                                   Signature                                         Date

                                          Send to: Andrea Beckman - CRB Director
                                                  310 S. 3rd Street, Suite 319
                                                  Las Vegas, Nevada 89155
                                                      Phone: 455-6322