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Portland Bureau of Emergency Management

Readiness. Response. Recovery.

Phone: 503-823-4375

Fax: 503-823-3903

TDD: 503-823-3947

Criminal Record Check
Volunteers with PBEM interact with vulnerable persons and populations, use city owned equipment, must use responsible judgment in stressful situations, and have access to sensitive information. Therefore, all volunteers must complete a criminal background check.

If an organization you are affiliated with (such as your employer) has undertaken a criminal record check on your record in the last 18 months, you do not need to complete this form. Instead, the organization that completed the check need only confirm that you passed a criminal records check by emailing the NET Coordinator at net@portlandoregon.gov.

If you have a license or permit that requires a criminal records check (such as teaching license or concealed handgun permit), you may scan a copy of that document and email it in order to fulfill the criminal records check requirement.

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Demographic Data

You can pick more than one racial category and chose Hispanic if you also identify as Hispanic.

Hold Ctrl to select multiple items

Citizenship

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e.g. 1120 SW 5TH or 5TH AND MAIN or 100-200 5TH
 
e.g. 1120 SW 5TH or 5TH AND MAIN or 100-200 5TH
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Past Residence

Please list all states you have resided in and the dates.

Other Countries

If you have lived in another country, please list along with the dates of residence.

Portland NET training is open to everyone, regardless of past offense records; no one will be barred from taking basic training. However, persons whose record includes a conviction(s) for a felony, sex crime that requires registration, stalking offense, person crime misdemeanor committed less than ten years ago, or non-person misdemeanor committed less than three years ago may not be certified as a NET volunteer and permitted to join a team.
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Have you ever harmed, or threatened to harm, a co-worker or supervisor at work?
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Have you ever been convicted of a criminal offense?

Informed Consent/Release and Hold Harmless Waiver ensuring confidentiality of Criminal Records Check

I recognize that the Portland Bureau of Emergency Management is conducting a criminal records check in relation to my volunteer service with the Bureau.

I understand that I am authorizing an investigation into aspects of my personal life to determine my fitness in relation to my volunteer service with PBEM. This investigation may include contacting persons or organizations that have information relating to my suitability.

I further recognize that although some of the information contained in this check is a matter of public record, or otherwise would be accessible to me, this information could be interwoven with other confidential information to which I would otherwise not be privy.

Therefore, I exonerate, release and discharge the City of Portland, the Portland Bureau of Emergency Management, its officers, or assigns, now and in the future, from any claim or damages, whether in law or in equity, on behalf of myself, my heirs, agents, or assigns, for their refusal to make available any and all information contained in this investigation, including but not limited to the identity of any person or organization who may have supplied information in the course of this investigation, as well as the substance of any such information supplied, even where such information has been the basis for my disqualification.

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