LONG HILL TOWNSHIP POLICE DEPARTMENT
___________ TOWNSHIP POLICE DEPARTMENT
POLICY AND PROCEDURE
POLICY:
The background investigations are an integral part of the selection process that provides the agency with knowledge about an individual that written and oral examinations do not provide. No employee shall be appointed until a detailed background investigation is conducted and reviewed by the Chief of Police.
PROCEDURES:
I. DIVISION COMMANDER IN CHARGE RESPONSIBILITIES
A. Assign a detective to complete the background investigation on applicant(s) prior to appointment.
B. Assist, if necessary, with background investigation.
1. Provide guidance.
2. Available resources.
C. Review reports prior to submission to the Chief of Police.
II. DETECTIVE RESPONSIBILITIES
A. Set up an interview with the applicant to explain the procedure and complete the department Background Investigation Report. (See Appendix 2)
B. Have applicant sign Release Authorization. (See Appendix 3)
1. Military Records, if applicable. (See Appendix 4)
C. Fingerprints are to be forwarded to the New Jersey State Police and the Federal Bureau of Investigation.
D. Photograph the applicant and attach to Background Investigation Report.
E. Advise the applicant of the confidentiality of all Background Investigation Reports.
F. Advise the applicant that he/she will be notified when the investigation is completed.
G. Have applicant acknowledge agency Essential Function Forms.
H. Verify all applicant credentials.
1. Eligibility requirements.
2. Verify all information furnished on the application.
III. BACKGROUND INVESTIGATION REPORT
The Background Investigation Report will be completed, as follows:
A. Investigative Report
1. If supplemental investigation, date of previous investigation. Transfer all information from previous investigation report to the current report.
a. Applicant information. Photostat copies of social security card and birth certificate.
b. If naturalized citizen, need copies of naturalization papers.
B. Social Status
1. If married, attach copy of marriage certification. If divorced, copy of Judgment(s) of divorce.
2. Spouse’s information
3. If divorced, interview former spouse.
4. All dependents must be listed.
5. Interview of applicant.
a. Have applicant explain reasons for errors and omissions in application.
b. An inquiry should be made to the applicant concerning drug usage, gambling and drinking.
6. Interviews of relatives/friends/associates/ other police officers. (See Appendices 5 and 6)
a. Ascertain if they know what police work involves and if they feel the applicant has the temperament and ability to get through the academy and handle the responsibilities of a police officer.
b. Any problems in neighborhood where applicant works.
c. Neighbors give good information which may help regarding the applicant working, while collecting unemployment, etc.
C. Education
1. Grammar school information.
2. High School Information
a. Get copy of high school diploma from applicant.
b. Get copy of high school transcript at high school.
c. Interview at least 2 guidance counselors/teachers, if available. If unable to find any teachers who remember the applicant, so note in report. (See Appendices 5 and 7).
d. Any disciplinary problems so note and get documentation to substantiate, if possible.
e. Get applicant’s reason for subject failures, absenteeism and tardiness.
3. College
a. Applicant’s responsibility to have transcripts forwarded to this department.
b. Get cumulative average and credits from transcripts, not from applications.
c. Any disciplinary problems so note and get documentation to substantiate, if possible.
d. Get applicant’s reason for subject failures, absenteeism and tardiness. (See Appendices 5 and 8 for sample cover letter and questionnaire)
D. Military
1. Get copy of Military Discharge papers, if available. Applicant should have same. (DD214 Form)
2. If Honorable Discharge with no other comment, no other records needed. If discharge medically, dishonorable, etc., letter will be sent with release form to St. Louis for records. (See Appendices 3 and 4).
E. Employment
1. Interview all employers since age 18.
2. List previous employment.
a. Check for gaps in employment.
3. Unemployment information will be requested from Department of Labor on all applicants.
a. Information will be added to the report.
b. Was applicant unemployed.
c. Was applicant working and collecting unemployment.
d. If there is an indication the applicant is working and collecting unemployment at the same time, information will be given to Department of Labor for further investigation. So note in report. (See Appendices 5 and 9).
F. Medical History
1. The applicant will only be required to provide medical/psychological histories following a promise of employment. However, condition of employment and subsequent appointment may be premised upon satisfactory results of both medical/psychological background information and/or the results of agency provided examinations.
2. List family physician and other physicians.
a. The investigator should contact the family doctor and ascertain if the applicant has had and serious illnesses or injuries.
b. Ascertain if the applicant is physically qualified to endure training at the academy.
c. If any serious illness or injuries, get copies of all medical records, if available; if not, note in report.
d. It is not necessary to get all medical records for minor illnesses and injuries such as colds, sore throat, etc. (See Appendices 5 and 10).
G. Criminal
1. The investigator will conduct criminal checks on the applicant through the county prosecutor’s office and the local police department where the applicant has lived, been employed or attended school. Check with the campus police if applicant attended college. (See Appendix 1)
a. If the applicant was arrested, attach all reports, if available. If not, so note in report.
b. Ask applicant if he/she has an expunged record. According to N.J.S.A. 2C:52-27.c, information divulged on expunged records shall be revealed by a petitioner seeking employment with a law enforcement agency and such information shall continue to provide a disability as otherwise provided by law.
c. If the applicant was arrested, attach all reports if available; if not, so note in investigation.
d. Question applicant regarding arrests. For example, his/her explanation, was it his/her fault?
(1). Note: If the applicant was arrested, indicted and found guilty of an indictable offense, he can be eliminated from the process, as per N.J.S.A. 40A:14-122.
(2). Procedure for termination: The investigator must contact the county clerk and obtain a “Certificate Judgment of Conviction” showing the charge and statute number and attach to report.
e. When fingerprints are submitted to the State Police for a records check of a police applicant or police employee, the Central Drug Registry will automatically be checked. If the applicant is logged the Central Drug Registry, the employing agency will be notified by State Police.
2. Central Drug Registry
a. Pursuant to the Revised Law Enforcement Drug Screening Guidelines, effective August 01, 1990, a Central Drug Registry was established by the Division of State Police, Records and Identification Section. This registry was established to record law enforcement officers, applicants for law enforcement officer, or law enforcement trainees who test positive for the presence of drugs in their urine, or who refuse to submit to a drug test.
b. In order to be entered into the Central Drug Registry, officers or trainees must be terminated from employment upon final disciplinary action. Applicants for law enforcement officer must have been removed from consideration for employment from the agency. Officers or trainees on suspension prior to final dismissal do not meet the criteria for entry into the Central Drug Registry.
c. It is the responsibility of the employing agency of the officer, applicant, trainee, or the agency that required the urine test, to provide written notification of the positive test result or refusal to submit to a drug test to the State Bureau of Identification (SBI). Notification to the Central Drug Registry must be on an official Township of Long Hill Police Department letterhead and include the following information regarding the officer, applicant, or trainee:
(1). Name of the Individual who Produced a Positive Test Result.
(2). Address of the Individual.
(3). Date of Birth.
(4). Social Security Number.
(5). Gender.
(6). Race.
(7). Eye Color.
(8). Substance(s) for Which the Individual Tested Positive.
(9). Date the Individual Tested Positive.
(10). Date of Dismissal from the Agency.
(11). Position of the Individual: Officer, Trainee, or Applicant.
(12). Reason the Individual was Tested, i.e., Officer Based on Reasonable Suspicion.
(13). Date of the Drug Test.(A.G. Law Enforcement Drug Testing Policy).
(14). Date of the Refusal.(A.G. Law Enforcement Drug Testing Policy).
d. Notification to the Central Drug Registry must be completed on a Township of _________ Police Department official letterhead and forwarded to the:
Division of State Police
Records & Identification Section State Bureau of Identification
P.O. Box 7068
West Trenton, New Jersey 08628-0068
Attention: Central Drug Registry
e. See Appendix # 14 for a sample format regarding submission to the Central Drug Registry. Questions concerning the Central Drug Registry should be directed to the New Jersey State Police at (609) 882-2000 extension 2467.
3. Federal Firearms Qualification
a. All applicants must complete a Federal Firearms Qualification Inquiry Form and it must be submitted along with the background investigation file.
4. The investigating officer will inquire with the Domestic Violence Central Registry.
Any information contained in the Registry will be fully investigated and noted on the
applicant’s background investigation.
H. Motor Vehicle
1. A motor vehicle abstract should be requested by the investigator’s department.
a. If none received, get motor vehicle record print out and attach to report.
b. Get copies of accident reports, if available. If not, so note in report.
2. Information regarding out-of-state driving records may be obtained by directing inquires to appropriate state capitals. ( See Appendix 12)
I. Vouchers
1. Question how long vouchers have known the applicant.
a. Any knowledge of the applicant using drugs or alcohol.
b. How long the applicant has expressed interest in law enforcement.
J. Summary
1. List any noteworthy information developed so oral board will be aware and question applicant. For example, absenteeism; failures in high school and college; employment record; comments of family members, neighbors, neighbors, teachers, employers, friends and vouchers; criminal, motor vehicle and financial.
a. Identify by investigation page, number and subtitle.
b. If at any stage of the background investigation, the candidate indicates that he/she desires to withdraw the application from future consideration, a letter from the applicant should be obtained.
IV. Civilian Employee
A. Background Investigation Report will be completed once the Application for Employment has been completed.
a. Secretary/Clerk
b. School Crossing Guard
c. Dispatcher
B. The background Investigation Reports for the Civilians will be completed on the Civilian Applicant Background Report. (See Appendix 13)
TOWNSHIP OF ___________
Police Department
, NJ 0
Application No. Formal
APPLICATION FOR EMPLOYMENT
Print: Last Name First Middle
Mailing Number Street or RD Number City
Address:
County State Zip Code
INSTRUCTIONS
Read carefully prior to filling out Application
These instructions are provided as a guide to assist you in properly completing your Formal Application for Employment. It is essential that the information be accurate in all respects. It will be used as a basis for a Background Investigation that will determine your eligibility for employment.
1. Your Formal Application for Employment should be printed legibly in ink. Answer all questions the best of your ability.
2. If a question is not applicable to you, enter N/A in the space provided. Leave no blank spaces.
3. Avoid errors by reading the directions carefully before making any entries on the form. Be sure your information is correct and in proper sequence before you begin. All time periods in your background must be accounted.
4. You are responsible for obtaining correct addresses. If you are not sure of an address, check it by personal verification. Your local library may have a directory service or copies of local phone directories.
5. An accurate and complete form will help expedite your investigation. On the other hand, deliberate omissions or falsifications may result in disqualification. Failure to return this application for enlistment properly completed, within ten (10) days, may result in removal or your name from further participation at this time.
AN EQUAL OPPORTUNITY EMPLOYER
PERSONAL DATA
1. What is your full name? _________________________________________________________
Last Name
_____________________________________________________________________________
First Name Middle Name
2. Give any other names you have used or been known by, and attach a statement, giving reasons (if none, so state.)
_____________________________________________________________________________
3. Where were you born? __________________________________________________________
City State
4. Birth Certificate: _______________________________________________________________
Number City or Town
_____________________________________________________________________________
State County
5. Date of Birth: _________________________________________________________________
Month Day Year
Age: ________________________ Sex: __________________ Height: ________________
Eyes: _______________________ Hair: _________________ Weight: _______________
White (non-Hispanic): ____________________ Black: (non-Hispanic: ________________
Hispanic: ______________ Asian American: ___________ American Indian: ___________
6. Social Security No.: ________________________________ State Issued: _______________
7. Do you wear contact lenses or glasses? Yes or No: __________________________________
If yes, explain: ________________________________________________________________
RESIDENCE
9. Where do you now reside? _______________________________________________________
Number Street/Avenue
_____________________________________________________________________________
City County State Zip Code
Telephone Number: (______) _____________________________________________________
Area
10. How long have you resided there: ________________________ With whom do you reside?
____________________________________________________________________________
Give Floor #: ________________ Apartment #: _____________________ (Check)
North ____ South ____ East ____ West ____ Front ____ Rear ____
11. If you reside with someone other than spouse of parent(s), list:
____________________________________________________________________________
Name Date of Birth Occupation
____________________________ List their place of employment:
Social Security #
________________________________ Address: ________________________________
____________________________________________________________________________
12. In chronological order, state each and every place in which you have lived during the past ten years, beginning with your present address.
From To Address (Street, Apt. #, City, State
Mo. Yr. Mo. Yr. Zip Code)
13. List all places where you registered or voted: (If none, so state)
County State Year County State Year
SOCIAL STATUS
14. Are you single ____, married ____, separated ____, divorced ____,
a widow ____, a widower ____?
15. Give following information regarding marriage or marriage, List number times married: ___
__________________________________________________________________________
Wife’s Maiden
When Where By Whom Name or
Husband’s Name
___________________________________________________________________________
___________________________________________________________________________
16. If separated, state reason: ______________________________________________________
17. If separated or divorced, what is the present address of that person? ____________________
___________________________________________________________________________
18. How many times were you legally or voluntarily separated? __________________________
19. Were you ever divorced or had a marriage annulled?
Yes or No _______________________ How many times ________________________
20. If ever separated, annulled or divorced, indicate which below and fill in required information:
___________________________________________________________________________
Separated/Annulled Date By Whom Where Issued Offending Party Reason
Divorced (indicate) Issued (Court & State) Decreed by Law
___________________________________________________________________________
21. Were you ever the parent of any children? (Include deceased)
Yes ______________ No _______________
22. List below every child born to you: (Include adopted and step children)
Date of Place of With Whom and Where
Name Birth Birth Does Child Reside
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
23. Are you supporting all children born to you, including adopted and step-children?
Yes or No: ___________ If no, state full details: __________________________________
_________________________________________________________________________
24. Have you ever been involved as a plaintiff or defendant in a paternity proceeding?
Yes or No: ___________ If yes, state full details: __________________________________
__________________________________________________________________________
25. If single, list name, etc. of at least one girlfriend/boyfriend:
Date of Occupation Social Phone
Name Address Birth Security Number
__________________________________________________________________________
__________________________________________________________________________
26. Give the name of your father, mother (maiden name), sister(s), brother(s), and spouse
(if deceased, so indicate):
Relationship Name Address Occupation Phone #
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
27. Family information: Father, Mother, Sister(s), Brother(s), Spouse:
Date of Place of Social
Relationship Name Birth Birth Security #
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
28. Family Employment: Father, Mother, Sister(s), Brother(s), Spouse:
Relationship Name Employer Address Phone
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
29. List names of three friends and/or associates other than vouchers:
__________________________________________________________________________
Name Full Address
__________________________________________________________________________
Full Date of Birth Occupation Social Security # Phone
__________________________________________________________________________
Name Full Address
__________________________________________________________________________
Full Date of Birth Occupation Social Security # Phone
__________________________________________________________________________
Name Full Address
__________________________________________________________________________
Full Date of Birth Occupation Social Security # Phone
==================================================================
List names of police officers employed within this county with whom you are socially or personally acquainted:
Name Address (if known) Badge # Social /Personal
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
30. List chronologically (earliest dates first) all schools, colleges and training courses you have attended:
___________________________________ ________________________________
School Exact Address
From _____ _____ To _____ _____ ______________ _________________
Month Year Month Year Day or Evening Last grade or term
___________________________________ ________________________________
School Exact Address
From _____ _____ To _____ _____ ______________ _________________
Month Year Month Year Day or Evening Last grade or term
___________________________________ ________________________________
School Exact Address
From _____ _____ To _____ _____ ______________ _________________
Month Year Month Year Day or Evening Last grade or term
___________________________________ ________________________________
School Exact Address
From _____ _____ To _____ _____ ______________ _________________
Month Year Month Year Day or Evening Last grade or term
___________________________________ ________________________________
School Exact Address
From _____ _____ To _____ _____ ______________ _________________
Month Year Month Year Day or Evening Last grade or term
31. What college degree(s) or professional license(s) do you possess?
_______________________________________________________________________
_______________________________________________________________________
Majoring in _____________________________________________________________
Grade Point Average (cumulative): ___________________________________________
Total Credits achieved towards degree: ________________________________________
32. Other than English, what language(s) do you
Speak: _________________________________________________________________
Understand: _____________________________________________________________
33. List any problems with school (absenteeism, tardiness, poor grades, other discipline problems), include college.
Date School Problems Explanation (Brief)
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
34. It is understood I will immediately have forwarded transcripts from all colleges attended: __________ (Check)
To: LONG HILL TOWNSHIP POLICE DEPARTMENT, 264 Mercer Street,
Stirling, New Jersey 07980-1483
Proper fee must be forwarded to the college by the applicant
MILITARY SERVICE
35. Have you ever served in an active military organization on any foreign government?
Yes or No: ________________
36. Have you ever served in a military organization of any foreign government?
Yes or No: ________________
If yes, give details: _________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
37. Give branch of service: ______________________________________________________
Military Specialty: _________________________________________________________
38. Rank held: _________________________ Service Serial # _________________________
39. If you have had no military service, give reason: __________________________________
____________________________________________________________________________
____________________________________________________________________________
40. How many periods of active service have you had (drafts, enlistment’s or recalls to service)
_______________________________________________________________________
Have you served outside the United States for any period(s) of time? If so, give details, locations , dates, etc.: ______________________________________________________
_______________________________________________________________________
_______________________________________________________________________
41. Give period or periods of active service:
From: ___________________________ To: ______________________________
From: ___________________________ To: ______________________________
From: ___________________________ To: ______________________________
From: ___________________________ To: ______________________________
42. List all medals and decorations awarded you as a member of the armed forces.
________________________________________________________________________
________________________________________________________________________
43. How many discharges or separations from the service were given to you?
_______________________________________________________________________
44. What is the type of your discharge(s) or separation(s) (honorable, dishonorable, honorable conditions, medical, etc.) Be exact.
________________________________________________________________________
Reason: _________________________________________________________________
________________________________________________________________________
45. Has your discharge or separation notice ever been corrected or changed?
Yes or No: ____________________
46. What was the nature of the change?
Changed from: _______________________ to ______________________________
47. Where you ever court-martialed, tried on charges, or were you the subject of a summary court, deck court, captain’s mast, company punishment, or any other disciplinary action?
Yes or No: ______________________ Number of Times ________________________
If yes, give details or charges, agency concerned, dates and dispositions.
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
48. Are you now or were you ever an active or inactive member of the Reserve Forces (any branch) or the United States, any foreign government, or the National Guard of any state?
Yes or No: ______________________ If yes, state which, active or inactive: ________
_______________________________________________________________________
Branch: __________________ Regiment: ______________ Unit: _____________
Rank: ___________________ Address __________________________________
From: ___________________ To: ______________________________________
SELECTIVE SERVICE
49. How many selective service classifications have you had?
_______________________________________________________________________
50. Were you ever classified 4-F? Yes or No: ________________________________
If yes, state reason: _______________________________________________________
_______________________________________________________________________
51. If not in 1-A, state reason(s): ________________________________________________
________________________________________________________________________
52. Selective Service #: _____________________ Local Board: ___________________
__________________________ Address: __________________________________
53. Last classification: ______________________ Date classified: _________________
EMPLOYMENT
54: Present Employer:
___________________________________________________________________________
Name/Company Address City/State Phone #
Date hired: _____________ Duties: ____________________________________________
55. Are you now engaged in any business as an owner (active or silent), partner, stockholder or corporate member? Yes or No: ___________ If yes, give details: _________________
___________________________________________________________________________
56. Has your name ever been submitted or used as a trustee, officer, or in any capacity, of any labor union, organization or affiliate? Yes or No: ________. If Yes, give details: __________
___________________________________________________________________________
57. List below chronologically earliest dates first, each and every place you were previously employed since the age of 18. OMIT NONE. Give correct, full addresses. Give dates of idleness between period of employment in proper sequence. (Include all part-time employment.)
From To Name & Address Immediate Reason
Mo. Yr. Mo. Yr. of Employer Supervisor For Leaving
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
58. Were you ever discharged or asked to resign from employment? Yes or No: _____________
How many times? ________________ Give details or discharge or forced resignation below.
Employer Employer’s Date Supervisor’s Reason
Address Name for Leaving
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
59. Were you ever subjected to disciplinary action in connection with any employment?
Yes or No _________________ If yes, give details: _____________________________
___________________________________________________________________________
60. a. Have you, your spouse, or any corporation or partnership of which he/she was an officer, director, or partner, ever possessed a license or permit (excluding driver’s license or learner’s permit) issued by any governmental agency?
Yes or No: _________ If yes, give details: ____________________________________
_________________________________________________________________________
_________________________________________________________________________
b. Have you, your spouse, ever possessed a professional or occupational license, permit or certification?
Yes or No: __________ If yes, give details: _____________________________________
__________________________________________________________________________
c. Has any license or permit (excluding driver’s license or learner’s permit) issued by any city, state or federal agency ever been denied to you, your spouse, or to any corporation or partnership of which you or your spouse was an officer, director, or partner? Has any such license or permit ever been revoked, canceled or suspended?
Yes or No __________ If yes, give details: _____________________________________
__________________________________________________________________________
__________________________________________________________________________
61. Have you ever sponsored, vouched for, served as character witness for, or made any recommendations for or concerning any person or premises to any municipal, state or federal agency in connection with the issuance, revocation, or suspension or any license or permit or for any other reason? Yes or No: ____________ If yes, give details: _________________________
_____________________________________________________________________________
_____________________________________________________________________________
62. Have you ever received unemployment insurance or other federal, state or local benefits or assistance? Yes or No: ______ Kind: _________________________________________
Local Office: __________________________ Address: ___________________________
_____________________________________________________________________________
Give periods:
From: _______________________________ To: _______________________________
From: _______________________________ To: _______________________________
From: _______________________________ To: _______________________________
Have you ever received any allowance to which you were not entitled? Yes or No: __________
If yes, explain: ________________________________________________________________
____________________________________________________________________________
63. Have you made application with this or any other police organization? Yes or No: __________
____________________________________________________________________________
Where When Present Status
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
64. Have you ever been rejected by another police department for employment? Yes or No: _____
When Where Why
___________________________________________________________________________
___________________________________________________________________________
65. Were you ever a member of a social, labor or fraternal organization? Yes or No: _________
From To Name of Organization Address Type of
Mo. Yr. Mo. Yr. Organization
___________________________________________________________________________
___________________________________________________________________________
*MEDICAL HISTORY
*Note-Questions 66-69 and 71-75 shall only be completed if the applicant receives an offer of employment. However, both conditions of employment and subsequent appointment may be premised upon the applicant’s medical and psychological histories along with agency
required examinations.
66. List below: (a) Family Physician. (b) Other Physician, Psychiatrist or Psychologist you have ever consulted.
Name Address City/State Phone #
(a). ________________________________________________________________________
(b). ________________________________________________________________________
(c). ________________________________________________________________________
67. Have you ever been examined or treated for a nervous or mental disorder by a private physician or at a clinic, hospital, sanitarium, or other institution or while in the military service?
Yes or No: _____________ If yes, give details: ____________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
68. Has any member or your immediate family ever had, or been treated for a nervous or mental disorder:
Yes or No: ______________ If yes, give details, including relationship:
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
69. Have you ever received psychiatric or psychoanalytic treatment: Yes or No: _____________
If yes, give details: ___________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
70. (a) Do you use, or have you used narcotics, marijuana, barbiturates, sleeping pills, etc.?
Yes or No: _____ If yes, give details and amount: ________________________________
____________________________________________________________________________
____________________________________________________________________________
(b) Do you use, or have you ever used alcoholic beverages? Yes or No: _____________
If yes, give extent and details: ____________________________________________________
____________________________________________________________________________
____________________________________________________________________________
71. Have you ever had, or been examined or treated by any doctor or hospital for any major illness, injury or physical defect (include childhood diseases)? Yes or No: ______________
If yes, give full details: _______________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
72. Do you have any deformities, restrictions or movement or amputations? Yes or No: __________
If yes, describe: ________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
73. Are you, or were you ever, a disabled veteran? Yes or No: ______________________________
74. Are you receiving a disability allowance at present? Yes or No: ____________________
Percentage of greatest disability? ________________ Present Percent: ________________
State nature of disability: _________________________________________________________
______________________________________________________________________________
75. Did you ever file a claim for VA disability? Yes or No: ____ If yes, state claim number:
_____________________________________________________________________________
76. Did you ever file a claim for Workman’s Compensation? Yes or No: _______
If yes, give date of injury: ________________________________________________________
_____________________________________________________________________________
77. Were you ever rejected as an applicant for life insurance? Yes or No: ____ If yes explain:
_____________________________________________________________________________
_____________________________________________________________________________
GENERAL
78. (a) Have you any loan, debt, garnishee, wage assignment or judgment pending against you?
Yes or No: _________ If yes, give details: ______________________________________
___________________________________________________________________________
___________________________________________________________________________
Type: Loan With Whom When Original Present Monthly Amount
Garnishee Name & Address Incurred Amount Amount Payments of Arrears
Judgment, etc.
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
(b) Have you ever received a student loan from a governmental or private agency?
Yes or No: ____________ If yes, give details: _____________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
(c) Did you ever default on such loan? Yes of No: ___ If yes, give details: _________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
79. Are you a co-maker on an outstanding loan? Yes or No: _____ If yes, give details: ___________
_____________________________________________________________________________
_____________________________________________________________________________
80. Have you ever been bonded? Yes or No: ______ With respect to each time bonded, state details:
Reason By Whom Date
Name & Address
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
81. Have you ever been refused a bond? Yes or No: ______ If yes, by whom: ________________
____________________________________________________________________________
____________________________________________________________________________
82. Were you or your spouse ever summoned or subpoenaed to court in a civil action or proceeding in this state or elsewhere, or could such a possibility ensure as a result or a recent occurrence or transaction? Yes or No: ______ Indicate below every civil action or proceeding in which you or tour spouse were a party and also the contingent possibility as described above.
Date Action As Plaintiff, defendant Court Disposition
Proceeding Petitioner, Respondent
or Witness
______________________________________________________________________________
______________________________________________________________________________
ARRESTS, SUMMONSES, ETC.
83. Have you ever been arrested for or charged with Juvenile Delinquency? Yes or No _________
If yes, insert information below.
Date Age Violation Location Charge Court Disposition Police Agency
Actual Reduced or Sentence Concerned
Charge
___________________________________________________________________________
___________________________________________________________________________
84. Have you ever been summoned, subpoenaed, requested or otherwise required to testify before any municipal, state or federal agency, committee or other investigative body? Yes or No: ___
If yes, give details: ____________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
85. Have you ever received a summons for any violation of the Fish and Game Laws?
Yes or No: _______ If yes, insert the information below:
Date Violation Location Court Disposition Your age Police Agency
at time Concerned
____________________________________________________________________________
86. Have you ever been arrested for, or charged with, a violation of the Disorderly Persons Act or city/township ordinance? Yes or No: _____ If yes, insert information below.
Date Violation Location Court Disposition Your age Police Agency
at time Concerned
____________________________________________________________________________
____________________________________________________________________________
87. Have you ever been arrested, indicated, or convicted for any violation of Criminal Law? Yes or No: ____ If yes, insert the information below.
Date Violation Location Court Disposition Your age Police Agency
at time Concerned
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
88. Have you ever had a criminal or arrest record expunged? Yes or No: ____ If yes, give details:
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
89. Have you ever been held as a material witness? Yes or No: __ If yes insert information below:
Date Violation Location Court Disposition Your age Police Agency
at time Concerned
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
90. Have you ever been held as a suspicious person or investigated by any law enforcement or private security agency for any reason? Yes or No: ___ If yes, insert information below.
Date Violation Location Court Disposition Your age Police Agency
at time Concerned
____________________________________________________________________________
____________________________________________________________________________
91. Have you ever been fingerprinted? (exclude only present application with this department) Yes or No: ____ If yes, fill in the following:
When Where Purpose
____________________________________________________________________________
____________________________________________________________________________
SUBVERSIVE AFFILIATIONS
92. Are you now, or have you ever been, a member of any Communist, Communist front, or other subversive organization, association, movement, or group, which advocates the overthrow of our constitutional form of government, or which seeks to alter the form of the government of the United States by unconstitutional or unlawful means? Yes or No: _____
93. Are you now, or have you ever been affiliated or associated with any of the organizations or groups described in question 92?
Yes or No: _____________
94. Are you now associating with, or have you ever associated with any individuals, including relatives, who you know or have reason to believe are, or have been, members of any organizations or groups described in question 92?
Yes or No: _____________
95. Have you ever participated in any parade, picket line, delegation, demonstration, affair, forum or project sponsored or organized by any organization or group described in question 92?
Yes or No ___
96. Have you ever participated in any of the following activities:
a. Attendance or participation in any parade, picket line, delegation, demonstration, affair, forum or project sponsored or organized by any organization or group described in question 92? Yes or No: _______
b. Payment or collection of any money dues, contributions or donations to any organization or group described in question 92? Yes or No: _______
c. Sale or distribution of any written or printed matter prepared, reproduced, or published by a group or organization described in question 92 or by any or its agents? Yes or No: _______
d. Purchased or subscribed to any publication or periodical prepared, reproduced, or published by any group or organization described in question 92 or any of its agents? Yes or No: _____
97. If you answered YES to any of the above questions, please explain.
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
____________________________________________________________________________
_____________________________________________________________________________
MOTOR VEHICLE HISTORY
98. Have you ever received a summons for violation of the Motor Vehicle Laws in this or any other state? (Exclude overtime parking violations) Yes or No: ______ If yes, insert the information below
Date Offense Location Court Disposition Your Age Police Agency
at time
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
99. Was your Motor Vehicle Registration Certification, Driver’s or other vehicle Operator’s license ever revoked? Yes or No: ______ Suspended? Yes or No: _______
If yes, which license: ____________________________________________________________
When: _______________________________ Where _____________________________
Why: ________________________________________________________________________
_____________________________________________________________________________
100. If answer to previous question is YES, was such Registration Certificate or Driver’s License ever restored? Yes or No: ____ When: ___________________ Where: __________________
101. Have you ever been involved in a motor vehicle accident either as a registered owner, operator, passenger or pedestrian. which resulted in any personal injury or property damage to you or anyone else? Yes or No: ______ If yes, state details: _________________________________
____________________________________________________________________________
____________________________________________________________________________
102. If you possess any of the following, complete the information below.
Item Number State Regular or Explain Date Expires
Conditional
Motor Vehicle
Registration
Passenger
Vehicle
Driver’s
License
(102. continued)
Item Number State Regular or Explain Date Expires
Conditional
_____________________________________________________________________________
Operator’ s
License for
any other
vehicle
103. Did you ever possess a chauffeur’s or operator’s license issued by any state other than New Jersey? Yes or No: ____ If yes, give city & state: ___________________________________
List name and address of company which carries your auto insurance:
_____________________________________________________________________________
_____________________________________________________________________________
Has your auto insurance ever been revoked or refused? Yes or No: ____ If yes, give details: ___
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
OTHER INFORMATION
104. Have you ever possessed any pistol, firearm, firearms ID card or dealer’s license in this or any other state? Yes or No: ____ Permit # _____________ Dealer’s License # _______________
Issuing Agency: _______________________________________________________________
Has any agency ever refused you such a permit or license?
Yes or No: ______ If yes, give details: ______________________________________________
_____________________________________________________________________________
105. Do you have any knowledge or information in addition to that specifically called for in the preceding questions which is or which may be relevant, directly or indirectly, in connection with an investigation of your eligibility and fitness for this position, including but not limited to, knowledge or information concerning your character, physical or mental condition, temperance, habits, employment, education, subversive activities, family, associations, criminal records, traffic violations, residence or otherwise. Yes or No: ____ If yes, give details:
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
VOUCHERS
(NOT TO BE SWORN MEMBERS OF THIS DEPARTMENT OR PERSONS
LISTED IN ANY OTHER SECTION OF THIS APPLICATION)
Upon completion of this form, the applicant must obtain three reputable citizens who will vouch for the honesty, reputation and ability of the applicant.
The voucher should read carefully all statements made by the applicant BEFORE SIGNING. Then, the voucher portion of the form should be completed by the voucher and signature affixed.
************************************************************************************
I, the undersigned, declare that I am over eighteen (18) years of age, that I have PERSONALLY known the applicant for at least one year, that I have read the whole of the foregoing application and believe all the statements therein to be true. I am not related in any way to the applicant.
I will, upon request, give further facts concerning the applicant as I may possess.
ALL INFORMATION WILL BE TREATED AS CONFIDENTIAL
VOUCHER ONE
(Please Print)
Name: ________________________________ Business Address: ___________________________
Address: _____________________________ Social Security #: ___________________________
(Optional)
_____________________________ Occupation (Optional): _______________________
City/State: __________________________ How long have you personally known applicant?
Telephone #: _________________________ __________________________________________
Date of Birth: _______________________ Is applicant of good character and reputation?
__________________________________________
Present Date: ________________________ Signature: _________________________________
VOUCHER TWO
(Please Print)
Name: ________________________________ Business Address: ___________________________
Address: _____________________________ Social Security #: ___________________________
(Optional)
_____________________________ Occupation (Optional): _______________________
City/State: __________________________ How long have you personally known applicant?
Telephone #: _________________________ __________________________________________
Date of Birth: _______________________ Is applicant of good character and reputation?
__________________________________________
Present Date: ________________________ Signature: _________________________________
VOUCHER THREE
(Please Print)
Name: ________________________________ Business Address: ___________________________
Address: _____________________________ Social Security #: ___________________________
(Optional)
_____________________________ Occupation (Optional): _______________________
City/State: __________________________ How long have you personally known applicant?
Telephone #: _________________________ __________________________________________
Date of Birth: _______________________ Is applicant of good character and reputation?
__________________________________________
Present Date: ________________________ Signature: _________________________________
STATE OF NEW JERSEY )
) SS
COUNTY OF )
I, _________________________________________________ being duly sworn, depose and say I am the above named person. I signed the foregoing statement. I personally read and printed by hand, answers to each and every question therein and I do solemnly swear that each and every answer is full, true and correct in every respect.
_____________________________________
Applicant's Signature
Sworn to before me this __________________
day of _________________________, 19 ___.
____________________________________
Notary Public or Commissioner of Deeds
Application mailed or delivered on _________________________________________________________
===========================================================================
DO NOT WRITE BELOW THIS LINE
____________________________________________________________________________________
____________________________________________ _____________________________
Signature of applicant made in presence of Investigator Date
_______________________________________
(Signature of Investigating Officer)
Appendix 2
TOWNSHIP OF LONG HILL
Police Department
POLICE APPLICANT INVESTIGATION
Detective Assigned: _________________________________ Date Assigned: ___________
Position: Police Officer
Subject: Investigation of ___________________________________________________________
First Middle Last
To: Chief of Police
From: ________________________________________________________________________
Rank First Middle Last I.D. #
Supplemental Investigation(s): Yes [ ] No [ ]
Date(s) of Previous Investigation(s) ___________________________________________
I. APPLICANT INFORMATION Social Security #_____________________
A. Other names used (maiden, etc.) _______________________________________________________
First Middle Last
B. Date of Birth: ___________________ ___________ _________________
Month Day Year
C. Place of Birth: _____________________ ________ ________________
City State County
1. Birth Certificate Attached [ ] Not Attached [ ]
If not, explain: ______________________________________________________________
__________________________________________________________________________
2. If naturalized: Attached [ ] Not Attached [ ]
If not, explain: _____________________________________________________________
__________________________________________________________________________
D. Height: _______ Weight: _______ Male [ ] Female [ ]
White [ ] Black [ ] Hispanic [ ] Other [ ]
Explain: ___________________________________________________________________________
__________________________________________________________________________________
II. SOCIAL STATUS
A. Marital Status:
Single ( ) Married ( ) Divorced ( )
Separated ( ) Engaged ( ) Other ( ) Explain:
________________________________________________________________________
B. Wife's Maiden/Husband's Name:
(include previous marriages) Date of Marriage
______________________________ __________________________
______________________________ __________________________
______________________________ __________________________
______________________________ __________________________
C. Date(s) of Divorce/Separation: _____________ County: ___________________
_____________ County: ___________________
Legal papers attached ( ) Not attached ( ) If not, explain:
________________________________________________________________________
D. Dependents:
Name D. O. B. Address Relation
______________________ ________ _______________________ ____________
______________________ ________ _______________________ ____________
______________________ ________ _______________________ ____________
______________________ ________ _______________________ ____________
______________________ ________ _______________________ ____________
E. Interview of Applicant: Date: ________________________ Time: ________
1. Home ( ) Work ( ) Other ( ) _______________________
2. Presence of: Spouse ( ) Mother ( ) Father ( )
Other ( ) _____________________________________________________________
(Explain)
3. Applicant's appearance: Neat ( ) Acceptable ( ) Disheveled ( )
Other ( ) Explain: _____________________________________________________
a. Home appearance: Neat ( ) Clean ( ) Dirty ( )
Need repair ( ) Other ( ) Explain: ______________________
__________________________________________________________________
__________________________________________________________________
4. Application Notarized: Yes ( ) No ( ) If no, explain:
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
5. Most important reason why Applicant wants to be a police officer.
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
6. Training, duties, salary, working conditions explained:
Yes ( ) No ( ) If no, explain:
_____________________________________________________________________________
_____________________________________________________________________________
7. Applicant:
Yes No How Often How Much
Drinks: ______ ______ ______________ __________________
Gambles: ______ ______ ______________ __________________
Drugs: ______ ______ ______________ ___________________
Investigator's Comments: _______________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
8. Hobbies/Interests (briefly): _______________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
9. Other Comments: ______________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
F. Interviews
1. Relatives' Comments:
Name Favorable Unfavorable No Comment
Mother ________________________ ( ) ( ) ( )
Father ________________________ ( ) ( ) ( )
Sisters/ ________________________ ( ) ( ) ( )
Brothers ________________________ ( ) ( ) ( )
________________________ ( ) ( ) ( )
________________________ ( ) ( ) ( )
Wife/Husband ____________________ ( ) ( ) ( )
Former Wife/
Husband ____________________ ( ) ( ) ( )
Relatives in
Police Work ______________________ ( ) ( ) ( )
Comments/explanations (identify by name): _________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
Investigator's Comments: _____________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
2. Friends/Associates/Other Police Officers
Name Affiliation Favorable/Unfavorable/No Comment
_________________________ __________________ ( ) ( ) ( )
_________________________ __________________ ( ) ( ) ( )
_________________________ __________________ ( ) ( ) ( )
_________________________ __________________ ( ) ( ) ( )
_________________________ __________________ ( ) ( ) ( )
_________________________ __________________ ( ) ( ) ( )
Comments/explanations (identify by name): __________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
Investigator's Comments: ______________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
Present Address: _____________________________________________________________
1. How Long? _____________________________________________________________
2. With Whom? _____________________________________________________________
First Middle Last D.O.B.
3. Neighbor Interviews (past 5 years):
Present (at least 2):
Name Address Favorable/Unfavorable/No Comment
______________________ _____________________ ( ) ( ) ( )
______________________ _____________________ ( ) ( ) ( )
______________________ _____________________ ( ) ( ) ( )
______________________ _____________________ ( ) ( ) ( )
Comments/explanations (identify by name): _______________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
Investigator's Comments: ____________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
List all previous addresses and dates for the past ten (10) years:
Date (from - to) Address(Number, Street, City, County, State)
____________________ ___________________________________________________________
____________________ ___________________________________________________________
____________________ ___________________________________________________________
____________________ ___________________________________________________________
____________________ ___________________________________________________________
____________________ ___________________________________________________________
____________________ ___________________________________________________________
____________________ ___________________________________________________________
____________________ ___________________________________________________________
____________________ ___________________________________________________________
Previous (at least 2):
Name Address Favorable/Unfavorable/No Comment
______________________ _____________________ ( ) ( ) ( )
______________________ _____________________ ( ) ( ) ( )
______________________ _____________________ ( ) ( ) ( )
______________________ _____________________ ( ) ( ) ( )
Comments/explanations (identify by name): _______________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
Investigator's Comments: ____________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
III. EDUCATION
A. Grammar School:
Name Address Attended From-To
_____________________________ ______________________________ _________________
_____________________________ ______________________________ _________________
_____________________________ ______________________________ _________________
_____________________________ ______________________________ _________________
B. High School:
_____________________________ ______________________________ _________________
_____________________________ ______________________________ _________________
_____________________________ ______________________________ _________________
C. High School Attendance Record:
Absent Tardy Attended From-To
9th Grade ________________ ________________ _________________________
10th Grade ________________ ________________ _________________________
11th Grade ________________ ________________ _________________________
12th Grade ________________ ________________ _________________________
D. Class Standing: # ________ out of _______ Students.
E. I.Q. Results available:
________________________________ ______________________
Score Test Name National Average Score
________________________________ ______________________
Score Test Name National Average Score
F. Interviews (at least 2):
Name Title/School Favorable/Unfavorable/No Comment
__________________________ _________________ ( ) ( ) ( )
_________________
__________________________ _________________ ( ) ( ) ( )
_________________
__________________________ _________________ ( ) ( ) ( )
_________________
Comments/explanations (identify by name): ___________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
G. Disciplinary problems: Yes ( ) No ( ) If yes, explain:
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
High school transcripts and diploma attached: Yes ( ) No ( ) If not, explain:
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
H. Investigator's comments: _________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
I. College:
Name Address Attended From-To
_________________________ ____________________ ____________________
_________________________ ____________________ ____________________
_________________________ ____________________ ____________________
_________________________ ____________________ ____________________
Cum. Av. _______________ Credits to Date: _______________________________
Investigator's comments: _____________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
Degrees (list type): ___________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
College transcript attached: Yes ( ) No ( ) If no, explain:
___________________________________________________________________________
___________________________________________________________________________
Other schooling (list name, dates attended, reason):
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
Disciplinary problems: Yes ( ) No ( ) If yes, explain:
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
Investigator's comments: _____________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
IV. MILITARY
A. None ( ) Army ( ) Navy ( ) Air Force ( ) Marines ( ) Coast Guard ( )
Other: _________________________________ (If none, leave the following blank:)
B. Rank: __________________________ Service Number: ________________________
Type/Date Discharge: __________________________________________________
Dates of Service (from - to): __________________________________________________
C. Problems during military: Yes ( ) No ( ) If yes, explain:
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
D. Military record attached: Yes ( ) No ( )
E. Investigator's comments: __________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
V. EMPLOYMENT
A. Present Employer(s) (list employers from most recent):
Name Address From-To Occupation
____________________ ___________________ _______________ ___________
____________________ ___________________ _______________ ___________
____________________ ___________________ _______________ ___________
Interview of present employer:
Name Title Favorable/Unfavorable/No Comment
______________________ _________________ ( ) ( ) ( )
______________________ _________________ ( ) ( ) ( )
Employer's Comments: ______________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
B. Previous Employment (since age 18):
Name Address From - To Occupation
________________ ___________________ ________________ ____________
________________ ___________________ ________________ ____________
________________ ___________________ ________________ ____________
________________ ___________________ ________________ ____________
________________ ___________________ ________________ ____________
________________ ___________________ ________________ ____________
________________ ___________________ ________________ ____________
________________ ___________________ ________________ ____________
C. Previous employers interviewed:
Name Employer Title Favorable/Unfavorable/No Comment
_______________ _____________ __________ ( ) ( ) ( )
_______________ _____________ __________ ( ) ( ) ( )
_______________ _____________ __________ ( ) ( ) ( )
_______________ _____________ __________ ( ) ( ) ( )
_______________ _____________ __________ ( ) ( ) ( )
_______________ _____________ __________ ( ) ( ) ( )
_______________ _____________ __________ ( ) ( ) ( )
Previous employers' comments: _________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
D. Unemployment:
Weekly Weekly
From-To Location Amount From-To Location Amount
__________ ____________ ________ ___________ ____________ ________
__________ ____________ ________ ___________ ____________ ________
__________ ____________ ________ ___________ ____________ ________
E. Any applications with police agencies (include State Police): Yes ( ) No ( )
Agency Name Location Date Applied Passed/Failed
_______________ _______________ ___________________ ______________
_______________ _______________ ___________________ ______________
_______________ _______________ ___________________ ______________
_______________ _______________ ___________________ ______________
_______________ _______________ ___________________ ______________
Investigator's comments (on employment/unemployment/other applications):
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
VI. MEDICAL HISTORY
A. Family Physician:
1. ______________________________________________________________________
(Name) (Address)
B. Other Physicians:
1. _______________________________________________________________________
2. _______________________________________________________________________
3. _______________________________________________________________________
4. _______________________________________________________________________
C. Medical problems of Applicant (vision, allergies, etc.) Yes ( ) No ( )
If yes, explain (attach doctor's report): ___________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
D. Medical problems of family members: Yes ( ) No ( ) If yes, explain:
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
Applicant's explanation of any problems: _________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
F. Physician's opinion: Is applicant physically qualified to endure the training at the police academy? Yes ( ) No ( )
G. Is attending physician's report attached? Yes ( ) No ( ) If no, explain:
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
H. Investigator's comments: ____________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
VII. CRIMINAL (of those names listed in application)
Yes No
A Record of: Applicant ( ) ( )
Family Members ( ) ( )
Friends/Associates ( ) ( )
Vouchers ( ) ( )
The following were checked for any record:
N.C.I.C./S.C.I.C.
State Bureau of Identification (State and FBI fingerprint cards)
FBI/DEA - Newark, New Jersey
N. J. Division of Criminal Justice
State Commission of Investigation
N. J. Division of Gaming Enforcement
(Attention: Deputy Director of Investigations)
B. List local agencies check (prosecutors/sheriff/local police, other)
__________________________________ __________________________________
__________________________________ __________________________________
__________________________________ __________________________________
__________________________________ __________________________________
__________________________________ __________________________________
C. Police reports attached: Yes ( ) No ( )
D. Applicant's explanation of arrest: _______________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
E. Investigator's comments on arrest(s): __________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
VIII. MOTOR VEHICLE
Number of Number of
A. Record: _______ No Record ______ Accidents: ________ Summonses: ________
B. D. L. #: _____________________ State: ________ Expiration Date: _________
C. List Vehicles owned:
Year Make Type/Color Plate #
____ ________________ _______________________________ _______________
____ ________________ _______________________________ _______________
____ ________________ _______________________________ _______________
D. Record explanation by applicant: _______________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
E. Investigator's comments: ____________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
IX. VOUCHERS
Name Occupation Favorable/Unfavorable/No Comment
__________________________ _______________ ( ) ( ) ( )
___________________________ _______________ ( ) ( ) ( )
___________________________ _______________ ( ) ( ) ( )
Unfavorable/No Comment explanations (Identify by name):
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
Investigator's comments (of vouchers, if any) _____________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
X. SUMMARY OF INVESTIGATION
A. Noteworthy information (list investigation report page number, subtitle, information uncovered):
Page # Subtitle Comments:
1. ________ ________________________ __________________________________
_______________________________________________________________________
2. ________ ________________________ __________________________________
_______________________________________________________________________
3. ________ ________________________ __________________________________
_______________________________________________________________________
4. ________ ________________________ __________________________________
_______________________________________________________________________
5. ________ ________________________ __________________________________
_______________________________________________________________________
7. ________ ________________________ __________________________________
_______________________________________________________________________
8. ________ ________________________ __________________________________
_______________________________________________________________________
9. ________ ________________________ __________________________________
_______________________________________________________________________
10. ________ ________________________ __________________________________
_______________________________________________________________________
11. ________ ________________________ __________________________________
_______________________________________________________________________
12. ________ ________________________ __________________________________
_______________________________________________________________________
13. ________ ________________________ __________________________________
_______________________________________________________________________
14. ________ ________________________ __________________________________
_______________________________________________________________________
15. ________ ________________________ __________________________________
_______________________________________________________________________
16. ________ ________________________ __________________________________
_______________________________________________________________________
17. ________ ________________________ __________________________________
_______________________________________________________________________
18. ________ ________________________ __________________________________
_______________________________________________________________________
19. ________ ________________________ __________________________________
_______________________________________________________________________
20. ________ ________________________ __________________________________
_______________________________________________________________________
21. ________ ________________________ __________________________________
_______________________________________________________________________
22. ________ ________________________ __________________________________
_______________________________________________________________________
23. ________ ________________________ __________________________________
_______________________________________________________________________
24. ________ ________________________ __________________________________
_______________________________________________________________________
25. ________ ________________________ __________________________________
_______________________________________________________________________
Report Reviewed By: _______________________________________ I. D. # __________
OPINION OF INVESTIGATOR
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
Appendix 3
TOWNSHIP OF ________________
Police Department
R E L E A S E A U T H O R I Z A T I O N
To all Courts, Probation Departments, Selective Service Boards, Physicians, Hospitals, Employers, Educational and other Institutions and Agencies without exception:
I, _______________________________________________________, am making application for appointment to the ____________ Township Police Department. As a result, an investigation is being conducted to determine my eligibility.
Therefore, you are authorized to release to the _________ Township Police Department or its representative any and all information, documentary or otherwise pertaining to me, that they may request. I hereby release, discharge and exonerate the Long Hill Township Police Department, its agents and representatives, and any person so furnishing information from any and all liability of every nature and kind arising out of the furnishing, inspection or collection of such documents, records, and other information or the investigation made by the ____________ Township Police Department.
A photostatic copy of this authorization will be considered as effective and valid as the original.
Date: _____________________________
Signature: _____________________________
Witness: _____________________________
APPENDIX #4
Insert
Appendix # 4
Here
Authorization For Release Of Military And Medical Information Form
APPENDIX #5
July 20, 1995
Mr./Ms. _____________________
_____________________________
_____________________________
_____________________________
Dear Mr./Ms. __________________
Mr./Ms: ________________ has applied for the position of Police Officer with this department. The applicant has informed us that you can furnish information which might be of assistance to us in reaching a decision as to whether or not the individual should be employed.
Will you please assist us by answering the questions on the attached questionnaire and returning it as promptly as possible. Please mail the questionnaire in the stamped, self-addressed envelope which is enclosed. Please note the applicant has authorized the release of the information requested, and a copy of that authorization is attached.
All information will be kept confidential.
Very truly yours,
Investigative Section
:
Enclosures
Appendix 6
TOWNSHIP OF ____________
Police Department
Concerning the Application of :_________________________________________________________
1. How many years have you known the applicant? _______________________________________
2. What is your relationship to the applicant? ___________________________________________
3. Are you aware of anything that might disqualify the applicant for public service? Yes [ ] No [ ]
Explain: _____________________________________________________________________
4. Would you describe the applicant as having integrity? Yes [ ] No [ ]
Explain: ____________________________________________________________________
5. Is the applicant dependable? ______________________________________________________
6. How would you describe the applicant's general reputation among his/her friends and associates?
_____________________________________________________________________________
7. Does the applicant have any significant financial problems? Yes [ ] No [ ]
Explain: ___________________________________________________________________
8. Are you aware of any substances abuse (alcohol, drugs) by the applicant? Yes [ ] No [ ]
Explain: ___________________________________________________________________
9. Has the applicant expressed or displayed any bias or prejudice towards others? Yes [ ] No [ ]
Explain: ___________________________________________________________________
10. Please list, if you can, the names of two other persons who may also know the applicant:
Name: _______________________________ Name: ______________________________
Address: ______________________________ Address: _____________________________
_____________________________________ _____________________________________
Phone #: ______________________________ Phone #: _____________________________
------------------------------------------------------------------------------------------------------------------
_____________________________________
(Print Name)
______________________________________ Date: _____________________________
(Signature)
Address: ______________________________
______________________________________
APPENDIX# 7
TOWNSHIP OF ______________
Police Department
Applicant’s Name: ___________________________________________________________________
1. When did you know applicant?
_________________________________________________________________________________
2. Would you describe the applicant as having integrity?
_________________________________________________________________________________
3. Did the applicant have any disciplinary problems in school?
_________________________________________________________________________________
_________________________________________________________________________________
4. Would you comment on the applicant’s learning ability?
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
5. Can you think of any reason why the applicant might not be qualified to become a police officer?
_________________________________________________________________________________
_________________________________________________________________________________
_____________________________________ Date: ____________________________________
(Signature)
Title: ___________________________________________
School: ___________________________________________
Appendix 8
TOWNSHIP OF ______________
Police Department
Name of School:__________________________________________________________________
Name of Applicant:__________________________________________________________________
Maiden Name:_________________________________________________________________
Date of Birth:_________________________ Place: _________________________________
1. What were the dates during which this individual was enrolled?
______________________________________________________________________________
2. Was a diploma or degree awarded to this person? Yes [ ] No [ ]
If yes, please provide the details:______________________________________________________
3. What was this person's overall grade point average or class standing? (Please submit a transcript.)
_________________________________________________________________________________
4. Was he or she ever suspended or placed on probation? Yes [ ] No [ ]
If yes, please describe the circumstances. ________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
5. Did this person ever have difficulty getting along with students, instructors or administrators?
Yes [ ] No [ ] If yes, please explain. _______________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
Name: __________________________________ Title: ______________________________
(Please Print) (Please Print)
________________________________________ Date: ____________________
(Signature)
Telephone Number: ______________________
Appendix 9
TOWNSHIP OF ______________
Police Department
Concerning the Application of:________________________________________________________
Employed by your firm from _____________________ to ______________________________
1. Are the employment dates listed correct? Yes [ ] No [ ]
If not, what are the correct dates? ___________________________________________________
2. Why was the applicant's employment terminated?
______________________________________________________________________________
______________________________________________________________________________
3. Is this applicant eligible for rehire? __________________________________________________
4. Was the applicant honest and truthful? _______________________________________________
5. How did the applicant get along with supervisors, co-workers and/or the public?
_____________________________________________________________________________
_____________________________________________________________________________
6. Was there any problem with absenteeism or excessive use of sick leave?
_____________________________________________________________________________
7. Do you have any record of salary garnishment or other financial problems of the applicant?
_____________________________________________________________________________
8. Did the applicant ever collect workman's compensation or other disability payments?
_____________________________________________________________________________
9. Can you think of any reason why the applicant might not be qualified to become a police officer?
_____________________________________________________________________________
________________________________________ _______________________________
Name (Please Print) Title (Please Print)
________________________________________ Date: __________________________
(Signature)
Address: ________________________________
________________________________________
Appendix 10
TOWNSHIP OF _______________
Police Department
Name of Physician: ____________________________________________________________________
Name of Applicant: ___________________________________________________________________
1. Dates Attended Complaints Duration of Describe
Month Year & Abnormal Illness Diagnosis Treatment or
Physical Operation
Findings
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
2. LABORATORY FINDINGS (Including X-Ray, ECG, BMR and pathological reports, etc., with dates)
_____________________________________________________________________________
3. Is this individual currently receiving treatment or taking medication for any medical problem, including emotional disorders? Yes [ ] No [ ]
If yes, please describe the nature of the problem._______________________________________
_____________________________________________________________________________
_____________________________________________________________________________
4. Have any other physicians or surgeons been consulted?
If so, please give name, date and nature of disorder. ____________________________________
_____________________________________________________________________________
5. Does this individual have any permanent disability or medical problem of which you are aware?
Yes [ ] No [ ] If yes, please explain. ________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
6. Do you know of any medical or other reason why this individual should perhaps not be employed as a Law Enforcement Officer? Yes [ ] No [ ] If yes, please explain.
____________________________________________________________________________
____________________________________________________________________________
(The back of this form may be used for any additional information in replying.)
________________________________________ Date: ________________________
(Signature)
Appendix 11
(Date)
The following named person is an applicant for a position as a police officer in this department and at one time resided or was employed in your jurisdiction:
Name of Applicant: ____________________________________________________________
Residence: ____________________________________________________________
Date of Birth: _____________________
Height: ________ Weight: ________
Social Security Number: _____________________
It would be of great assistance to us if you would check your file and advise us whether or not this person has ever come to your attention. If any derogatory information is obtained, a brief synopsis will assist in determining his/her suitability for employment. You may use the bottom or reverse side of this letter in replying.
Thank you for your cooperation.
Sincerely yours,
Enclosure: Release Authorization
APPENDIX # 12
TOWNSHIP OF _________________
Police Department
Insert Appendix # 12 Here
Three (3) Pages
OUT OF STATE DRIVING RECORDS
Appendix 13
TOWNSHIP OF ________________
Police Department
BACKGROUND CHECK REPORT
I. R. #: _______________________
_____________________________________ __________________________________________
(Applicant's Name) (Current Address)
Name and Residence Confirmation Comments: ______________________________________________
____________________________________________________________________________________
List all addresses for the past three years: Local Police Department:
1. ____________________________________________ ___________________________________
2. ____________________________________________ ___________________________________
3. ____________________________________________ ___________________________________
LOCAL POLICE DEPARTMENT CHECK
Department Person Contacted/Date Contacted Phone #
____________________________ __________________________________ ________________
____________________________ __________________________________ ________________
____________________________ __________________________________ ________________
Comments: __________________________________________________________________________
____________________________________________________________________________________
Employment Confirmation Comments: ____________________________________________________
Investigation Checks:
Long Hill Township: Record [ ] No Record [ ] See Comments [ ]
S.B.I. Fingerprint: Record [ ] No Record [ ] See Comments [ ]
FBI/NCIC: Record [ ] No Record [ ] See Comments [ ]
Motor Vehicle Abstract: Record [ ] No Record [ ] See Comments [ ]
Comments: __________________________________________________________________________
____________________________________________________________________________________
Investigation Summary: ________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
Approved Not Approved
__________________________________ _______________________________________
(Date) (Investigating Officer)
-----------------------
CROSS REFERENCE #
VOLUME:
CHAPTER:
# OF PAGES: 8
PAGE: #
REVISION
__________ TOWNSHIP
POLICE DEPARTMENT
CHIEF OF POLICE
EFFECTIVE DATE:
SUBJECT: BACKGROUND INVESTIGATIONS
................
................
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