PA Chiefs_Bulletin Winter_2016

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PENNSYLVANIA
CHIEFS OF POLICE
ASSOCIATION
APPLICATION TYPE:
o Active Membership
$150 per year plus $100 Initiation Fee
($250 to accompany application)
o Affiliate Membership
$150 per year plus $100 initiation Fee
($250 to accompany application)
3905 North Front Street | Harrisburg, PA 17110 | Tel: 717-236-1059 | Fax: 717-236-0226 |
¨ CHECK HERE FOR A MAILED COPY OF THE BULLETIN...$25 PER YEAR
Please type or print clearly.
APPLICANT INFORMATION
Name_ ________________________________________________
Rank ___________________________ Date of Appt___________
Full Name of Employer_ __________________________________
Office Address _ ________________________________________
______________________________________________________
______________________________________________________
County _____________________ Phone _ ___________________
Fax ___________________ Email _ _________________________
Are you a sworn police officer? Y or N
Full Time Police Officer in Above Department? Y or N
MPOETC # ___________________________________________
If not applicable, please explain why MPOETC number is not present _
______________________________________________________
Residence Address ______________________________________
______________________________________________________
______________________________________________________
County ____________________ Phone _ ____________________
Date of Birth _______________ Region _____________________
Have you ever been convicted by a Court of Record of the
commission of a felony or misdemeanor? Y or N
If yes, explain on a separate sheet of paper and attach to
application form.
Signature of Applicant:
______________________________________________________
MAIL TOTAL FEE AND THIS FORM TO:
PA Chiefs of Police Association
3905 North Front Street, Harrisburg, PA 17110
For office use:
Check Amount & No. ______________ Date __________________________
RECOMMENDING MEMBER
Please list a current member of the Pennsylvania Chiefs of
Police Association who has recommended that you apply for
membership. If the applicant holds a rank lower than
Chief, your recommending member must be your Chief,
Superintendent or Commissioner.
Recommending Member Name and Title:
______________________________________________________
Department Name and Phone Number:
______________________________________________________
APPLICANT DEPARTMENT INFORMATION
Provide the number of sworn police officers in your department
Full time ___________ Part time __________
If industry, number of security officers under applicant’s
command ___________
If other, state nature of business in relation to law enforcement
______________________________________________________
______________________________________________________
______________________________________________________
MEMBERSHIP QUALIFICATIONS
Section 4. Active Membership. “Active” membership shall be open to the following:
(a) All full-time sworn chiefs of police, superintendents, or commissioners of municipal
police agencies in the Commonwealth of Pennsylvania who have police powers
and MPOETC Certification (b) All full-time sworn municipal police officers in the
Commonwealth of Pennsylvania who have police powers, MPOETC Certification and
hold the rank of captain or above and persons who hold the rank of Captain or above
that are members of the Pennsylvania State Police; (c) Special agents in charge, assistant
special agents in charge, and resident agents of any law enforcement entity of the
United States government if, at the time of application, such persons are headquartered
in the Commonwealth of Pennsylvania; and; full-time persons with command-level
responsibility in any law enforcement agency of the Commonwealth of Pennsylvania
provided that these individuals are not elected to their position by a popular vote of
citizens Section 5. Affiliate Membership. “Affiliate” membership shall be open to those
persons who, by occupation are Chiefs of Police who work part time, Police Officers
In Charge of Police Departments, Directors of Police Agencies, and Ranking officers
who have a supervisory role in a police department. This category also includes agency
heads of Corporate Security and Police Academies . These individuals must share a
mutuality of interests with the Association and its membership, enabling them access to
information from the Association that is regularly provided to Active Members. Affiliate
members may attend the Association’s Annual Meeting at the invitation of the Executive
Board and under no circumstances shall such members have or exercise the privilege of
voting, either by voice or ballot, on Association business. For the full by-laws regarding
membership, please visit our website at
APPLY
ONLINE!