Ana səhifə

Colorado springs police department personal history questionnaire


Yüklə 0.72 Mb.
səhifə1/8
tarix22.06.2016
ölçüsü0.72 Mb.
  1   2   3   4   5   6   7   8

COLORADO SPRINGS POLICE DEPARTMENT



PERSONAL HISTORY QUESTIONNAIRE





The Colorado Springs Police Department is certified by the Commission on Accreditation for Law Enforcement Agencies (CALEA), Inc. and is an Affirmative Action/Equal Opportunity Employer


Last Updated October 8, 2012

APPLICANT ACKNOWLEDGMENT
I understand that my signature verifies I have read and understand the following information:


  • I certify that statements, information and documents provided with regard to this Personal History Statement are true and complete.




  • I understand that failure to submit a complete statement or comply with the procedures established for submitting such statement could disqualify me for consideration for employment without prior notification. I also understand that omissions, discrepancies, conflicting information, misleading statements, false information, or evidence of fraud or deceit in any manner associated with my application, subsequent testing, or consideration for employment will disqualify me and constitute grounds for discharge, if hired.

  • In addition, I give the City of Colorado Springs the right to investigate and verify any information obtained through this application. Permission is granted and I release from any and all liability any employer, agency or individual assisting the City of Colorado Springs in providing relevant, job related information that will assist in this process.




  • I understand that the Colorado Springs Police Department may obtain a driving history and criminal records check as part of the background process.




  • I understand that I am required to submit official college/university transcripts with this questionnaire so that the Colorado Springs Police Department can verify that I meet the educational minimum qualifications.




  • If I am an honorably discharged veteran, I understand that I must submit an unedited version of my DD Form 214, or other suitable documentation, so that the Colorado Springs Police Department can verify my eligibility for veteran’s preference in testing.




  • I am aware that all submitted documents will not be returned to me or retrieved from my file for any reason, thus I have submitted true copies where applicable.

  • I understand that a final employment offer as a Police Recruit with the City of Colorado Springs is contingent upon successful completion of a pre-employment alcohol/drug test, medical examination, polygraph examination, psychological evaluation, and background check. Background checks include, but are not limited to, work and personal references, driving records, criminal records, employment history, military service, and educational attainment.

  • If employed, I agree to provide proof of identity, relevant licensure or credentials, and authorization for employment in the United States.

  • If employed, I agree to abide by all policies, regulations and guidelines established by the City of Colorado Springs.















Candidate’s Signature







Date

COLORADO SPRINGS POLICE DEPARTMENT

PERSONAL HISTORY QUESTIONNAIRE
INSTRUCTIONS
Complete this statement in full and with as much detail as possible. This statement will be provided to a background investiga­tor to assist him or her in evaluating your suitability for employment.


  • All questions must be answered completely and accurately. If a question does not apply, write N/A in the space provided. Avoid errors by reading the directions carefully before making any entries on the form. Make sure your information is correct and in proper sequence before you begin.




  • You are responsible for obtaining correct addresses, including zip codes and counties. Your local library may have a directory service or copies of local telephone directories to assist you.




  • Whenever a report of an incident is required, be sure that you give all facts pertaining to it. Present the information in such a manner that any person unfamiliar with the situation will be provided with all the details and facts in the order in which they occur. Include the approximate dates or times the events took place and the names of persons or organizations involved.




  • If there is not sufficient space on the form for you to include all the information required, the additional information should be placed on another sheet of paper and the item(s) properly identified by restating the question being answered.




  • Remember, every item will be checked and verified. Careful, accurate and complete answers will help us to verify the information that you provide.




  • You are expected to actively assist your Background Investigator in obtaining any additional information that he or she needs.




  • We recommend that you retain a copy of your PHQ once it is filled out.

Complete the three waiver forms at the end of this packet and return them to us with the Personal History Questionnaire. Please note that the Release of Information Form must be notarized.


Mail the completed questionnaire and waivers to the following address:
Colorado Springs Police Department

Human Resources, MC 1565

705 South Nevada Avenue

Colorado Springs, CO 80903
If you have any questions regarding completion of this questionnaire, contact the Colorado Springs Police Department Human Resources at 719/444-7447.


Please complete the following information. Fields in gray need your input.

You can use the TAB key to quickly navigate to each field.


PERSONAL

Date Submitted:

     




Social Security Number:

     

Name:

     



     

     

     




First

Middle

Last

Maiden (if applicable)

Other names you have used or by which you have been known, including nicknames. Give explanation for them:

Name:

     

     

     

     




First

Middle

Last

Explanation

Current Address:

     

     

     

     

     




Street

City

County

State

Zip

Home Phone:

     

Work Phone:

     

Cell Phone:

     







Email Address:

     

Date of Birth:

     




Place of birth:

     

     

     







City

County

State

With whom do you reside?

     

Do you possess a valid driver’s license?

 Yes  No

From what state?

     

License Number:

     

Type (operator, chauffer, etc.)

     

Expiration Date:

     

Sex:

     

Age:

     

Height:

     

Weight:

     

Hair:

     

Eyes:

     

Ethnicity:












Are you a citizen of the United States?

 Yes  No

If no, list country of citizenship:

     

If no, are you in the United States legally and have a legal right to work here?

 Yes  No

Are you fluent in any language other than English?

 Yes  No

List language(s)

     

Are you single, married, separated, divorced or widowed:




Name of spouse/significant other/boyfriend or girlfriend:

     

Age:

     

Spouse/Significant Other Work Phone:

     

Cell Phone:

     

Email Address:      




Maiden name of spouse, or other name he/she might be known by:

     

Date of marriage:

     

Location of marriage ceremony:

     



























If separated, divorced or annulled, answer the following questions:

Name of former spouse:

     

     

     

Date of marriage:

     







First

Middle

Last










Maiden name of former spouse, or other name he/she might be known by:

     

Location of marriage ceremony:

     

     

     







City

County

State

Email Address::

     

Former spouse’s phone:

     

Cell phone:

     

Former In-laws: (Name, Address, Phone)

     

     

Title of court issuing decree:

     

Date filed:

     

Date granted:

     

On an additional piece of paper, add the identical information on any additional separations, divorces or annulments.

























DOMESTIC VIOLENCE INQUIRY

Are you currently, or have you ever been in the past, subject to a domestic restraining order, including a permanent restraining order, temporary restraining order, or emergency restraining order?  Yes  No

If yes, provide the following information with respect to that order:

Court/Jurisdiction

     

Docket/Case Number

     

Date(s) imposed

     

Disposition

     

Have you ever been charged with a Crime of Domestic Violence, in any court anywhere, including a military tribunal?  Yes  No

An offense that is Domestic Violence Related under federal or state law includes the commission of a crime* against the following person’s:

a. A current or former spouse, parent or guardian of the victim

b. A person with whom the victim shares a child in common

c. A person who is cohabiting with or has cohabited with the victim as a spouse, parent, or guardian

d. A person similarly situated to a spouse, parent or guardian of the victim

























* These crimes can include: property crimes, threats, physical violence, obstruction of communications, stalking, etc.

If you have ever been charged with a Crime of Domestic Violence, provide the following information with respect to the charge:



Court/Jurisdiction

     

Docket/Case Number

     

Statute/Charge

     

Disposition (convicted, dismissed, etc.)

     

Date Sentenced

     

If the Sentence was deferred, conditions of deferment:

     

a. Was your case dismissed?













 Yes  No

b. Was your conviction expunged?













 Yes  No

c. If any of your civil rights were removed as a result of the conviction, have they been restored?

 Yes  No

























If you answered “yes” to any of these questions, attach copies of documents verifying your response.

************************************************************************************

If you have been charged more than once with a Crime of Domestic Violence, provide the same information as above for each incident on a separate sheet(s).

************************************************************************************

Describe ANY domestic violence incidents in which you were involved, whether reported or not reported:

     

  1   2   3   4   5   6   7   8


Verilənlər bazası müəlliflik hüququ ilə müdafiə olunur ©kagiz.org 2016
rəhbərliyinə müraciət