barnstable police department police application.pdf · police officer candidates . j ... due to the...

Truro Police Department 344 Route 6 P.O. Box 995

Truro Massachusetts 02666-0995 508-487-8730

Personal History Form For

Police Officer Candidates

J

“A STATE ACCREDITED POLICE AGENCY” TO: All Truro Police Department Applicants

FROM: John R. Lundborn, Chief of Police

One of the most critically important issues that define the effectiveness of any organization is the perception that it is a credible organization. Central to that image is the integrity and truthfulness of the department’s employees, from the newest entrant through the top-level managers. The need for honest, impartial and accurate representation of facts is nowhere more vital than within a law enforcement agency where success or failure rests with the degree of public support it receive s. Public support can quickly erode where there is a lack of credibility in existence within the organization.

The very basis of a n individual’s integrity, as perceived by the public, friends and fellow workers is at stake whenever the truth is not told. The loss of integrity by an individual or group of individuals can quickly spread throughout the department.

As Chief, it is my responsibility to maintain the effectiveness of the Truro Police Department as a viable law enforcement agency. This document serves notice that I will not tolerate untruthfulness of any kind by any member of this department, including applicants. You are therefore advised that all information disclosed or gleaned during the application process will be verified by means of a thorough integrity-based background investigation.

Any statements or omissions, either written or verbal, given by an applicant, which prove to be false or misleading, will result in the applicant being disqualified from further consideration and/or termination from employment with the Truro Police Department. There is no substitute for the truth.

Our rules are stringent because we care deeply about the image we portray in our community and throughout the nation. Due to the rules and regulations governing the department, and Massachusetts General Laws, we cannot consider police officer candidates that smoke, and cannot consider any candidates that have tattoos and/or body piercings that would show on duty or in any one of our uniforms.

I have read and understand the letter above

_________________________________

Signature of Applicant

_________________________________

Name and Address of Applicant

344 Route 6, Post Office Box 995, Truro, Massachusetts 02666-0995 508-487-8730 www.truropolice.org

RULE 15.4 - POLICE OFFICER

A. SUMMARY

A Police Officer shall be responsible for the efficient performance of his duties in conformance with the rules, regulations, and policies contained in this Manual.

His duties shall consist of, but are not necessarily limited to, a number of general police responsibilities necessary to the stability and safety of his community. He shall be expected to:

1. Identify criminal offenders and criminal activity and, where appropriate, apprehend offenders and participate in subsequent court proceedings.

2. Reduce the opportunities for the commission of crime through preventive patrol and other measures.

3. Aid individuals who are in danger of physical harm.

4. Facilitate the movement of vehicular and pedestrian traffic.

5. Identify problems that are potentially serious law enforcement or governmental problems.

6. Create and maintain a feeling of security in the community.

7. Promote and preserve the peace.

8. Provide other services on an emergency basis.

9. Perform other related duties as required.

B. DUTIES AND RESPONSIBILITIES

It is the duty and responsibility of a Police Officer to:

1. Exercise authority consistent with the obligations imposed by his oath of office and be accountable to his superior officers, promptly obeying legitimate orders.

2. Coordinate his efforts with those of other members of the Department so that their teamwork may ensure continuity of purpose and maximum achievement of police objectives.

3. Communicate to his superiors and to fellow

officers all information he may obtain which is pertinent to the achievement of police objectives.

4. Respond punctually to all of his assignments.

5. Acquire and record information concerning events that have taken place since his last tour of duty.

6. Record his activity during his tour of duty in the manner prescribed by his superiors. Complete detailed reports on all crimes, vehicle accidents and other incidents requiring police attention. In cases where an arrest is made, an arrest report is submitted along with the required crime reports. When property is recovered or additional information is discovered pertaining to a previously reported offense, the officer completes an investigation report.

7. Maintain his weapons and equipment in a functional, presentable condition.

8. Assist citizens requesting service, assistance, or information, and courteously explain any instance where jurisdiction does not lie with the Police Department and suggest other procedures to be followed.

9. Be accountable for the securing, receipting, and proper transporting of all evidence and property coming into his custody.

10. Be alert to the development of conditions tending to cause crime, take preventive action to correct such conditions, and inform his superiors as soon as the situation permits.

11. Conduct a thorough investigation of all offenses and incidents within his area of assignment and scope of activity. He shall collect evidence and record data which will aid in identification, apprehension, and prosecution of offenders and the recovery of property.

12. Patrol an assigned area for general purposes of crime prevention and law enforcement. Pay special attention to any conditions conducive to crime or indicative of criminal activity. Patrol includes: apprehending persons violating the law or wanted by the police; public assembly checks; building security checks; observation and interrogation of suspicious persons; issuing traffic citations; locating fires; reporting street light and traffic signals out-of-order, street hazards and any conditions that endanger public safety; checks of schools, parks and playgrounds; responding to any public emergency.

13. Respond to situations brought to his attention while in the course of routine patrol or assigned by radio. Render first aid to persons who are seriously ill or injured. Assist persons needing police services.

14. Answer questions asked by the general public, counsel juveniles and adults when necessary and refer them to persons or agencies where they can obtain further assistance.

15. Preserve the peace at public gatherings, neighborhood disputes and family quarrels.

16. Serve or deliver warrants, summonses, subpoenas, and other official papers promptly and accurately; when so directed by a superior officer.

17. Confer with court prosecutors and testify in court.

18. If assigned to operate motor vehicle, see that it is well maintained mechanically and that it is kept clean both inside and out. Inspect the vehicle at the beginning of the tour of duty for any defects or missing equipment. Immediately report all defects and damages sustained to the vehicle to the proper authority and complete all reports and forms required by current procedures. Use the call number assigned to the car to contact headquarters. Operate the radio in line with FCC regulations and current departmental procedures.

19. Remain on his assigned route throughout his tour of duty except when a police emergency necessitates a temporary absence, or when a superior officer or the Dispatcher has issued such authorization.

20. Patrol every part of his beat giving particular attention to and frequently rechecking locations where the crime hazard is great. Insofar as possible, he shall not patrol his area according to any fixed route or schedule, but shall alternate frequently and back track in order to be at the location least expected.

21. Be alert for all nuisances, impediments, obstructions, defects or other conditions that might endanger or hinder the safety, health or convenience of the public within his patrol area.

22. Take measures to direct the flow of traffic in his area during periods of congestion. If more than a temporary absence from his regular duties is required, notify the Commanding Officer.

23. Make periodic reports to the station house.

24. Keep radio equipment in operation at all times and be thoroughly familiar with departmental policy concerning use of the radios.

25. Observe the following when assigned to

traffic duty:

a. Direct and expedite the flow of traffic at assigned intersections keeping in mind his duty as a traffic Police Officer in preventing accidents, protecting pedestrians and ensuring the free flow of traffic.

b. Enforce the parking ordinances and motor vehicle laws in his area.

c. When called from a traffic post for emergency police service, respond immediately and notify the station at the earliest possible opportunity.

d. Wear the prescribed traffic safety clothing and equipment.

TRURO POLICE DEPARTMENT Personal History Form for Police Officer Applicants

John R. Lundborn Chief of Police

IMPORTANT INSTRUCTIONS

This document is a permanent record. All information must be typed or neatly printed by the applicant, using black ink only. Illegible or incomplete applications will not be accepted. Do not write in shaded areas. It is mandatory that all information requested be supplied in the manner specified. Each question on this application must be answered; leave no blanks. If a question does not apply, enter DNA. All questions must be answered truthfully. Willfully withholding information or making false statements on this document may be the basis of rejection of the application or immediate dismissal from the Truro Police Department if an appointment has been made. You may be notified to appear at the Truro Police Department located at 344 Route 6, Truro, MA for processing. If notified, you should anticipate approximately 1/2 hour being required for your processing. You will be photographed, fingerprinted and may have an initial interview with selected members of the Truro Police Department.

1. Read the entire form carefully. 2. Prior to writing upon this application, you must photocopy the application in the event additional space is needed to

include all the information required. 3. List zip codes and area codes for all requested addresses and telephone numbers. 4. Print full names of all individuals listed. If the individual has no middle name or initial, indicate by printing NMI. 5. Read and follow the specific instructions for each section. 6. If there is insufficient space to include all information required, place a photocopy of that page in proper sequence

and complete the information. 7. Certain questions will require a written explanation on a separate piece of paper. These will be indicated by the

phrase “required written response”. This is your opportunity to give your version of the event; be specific and detailed in your explanation. Utilize page 33 or an 8-1/2” by 11” piece of paper. Attach the written response in proper sequence. The page must be labeled to match the question you are responding to. If you wish to furnish additional information or an explanation regarding any question in the form, follow the same instructions.

8. You are required to report any changes to information on the Personal History Form within FIVE days to the Truro Police Department. Failure to do so may be the basis of rejection of the application or immediate dismissal from the Truro Police Department if an appointment has been made.

9. The release of information form must be filled out and notarized. DO NOT write in the two blanks on the first page of the release of information form.

10. SSA form 3288 must be filled out and signed, as well as all attachments.

I have read and understand the instructions provided. Signature of Applicant Date Printed Name of Applicant Receipt: Date: Time:

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TRURO POLICE DEPARTMENT

Personal History Form for Police Officer Applicants

The following documents are required with your application.

DOCUMENTS

Copy Attached

N/A

You Will

Provide By (Date)

Massachusetts Driver’s License (Copy)

Social Security Card (Copy)

Your Birth Certificate (Copy)

Passport (if applicable) (Copy)

High School Diploma (Copy)

GED Certificate (if applicable) (Copy)

Selective Service Card (if applicable) (Copy)

Higher Education Diploma (for each degree claimed)

Official Transcript for Each College Attended (Copy)

Military DD214 Service Discharge Form (if applicable) (Copy)

Signed Copies of Your State Tax Returns for the Past Three Years

Signed Copies of Your Federal Tax Returns for the Past Three Years

Completed and Signed Social Security Form 3288

Citizenship or Naturalization Papers (if applicable) (Copy)

Divorce Decree(s) (Copy)

Bankruptcy Records (Copy)

Civil Suit Records (Copy)

Name Change Records (Copy) Any Recommendations, Certifications, or Training Documents You Wish to Provide

LAW ENFORCEMENT TRAINING RECORDS (if applicable)

Academy Certification(s) (Copy)

Letter indicating successful completion of PAT (if applicable) (Copy)

Specialized Law Enforcement Training Course Certificate(s) (Copy)

Recent Police Report Writing Samples (minimum of five) (Copy)

TRURO POLICE DEPARTMENT Personal History Form for Police Officer Applicants

Personal Full legal

name Last

First

Middle

Social Security Number Driver’s License No. State Expiration Date

Date of Birth Place of Birth (city, county, state, and country)

List all names (aliases) you have used or have been known by (include maiden name). If you have ever used any surname other than your true name, during what period and under what circumstances were these names used? Last First Middle Year(s) Used Reason

If you have ever used another social security number for any reason, list the number(s) and the dates and reason for its use.

U.S. Citizen Naturalized Citizen Naturalization #: Location Naturalized

List the current address where you physically reside (not a mailing address).

Number, Street, and Apt. No. City State Zip Code

Name of the county where you reside Rent Own Parent Other (explain) How long have you resided there? Years: Months:

Residence Work List your residence and work phone numbers (include area codes and extension if applicable).

Email address: Cellular phone

List a mailing address if unable to obtain mail at your residence Mailing Address City State Zip Code

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Family Members and Relatives

During the background investigation, your family and other relatives may be asked to comment upon your suitability for the position of police officer. Supply the appropriate information in the spaces provided. If a category is not applicable, print N/A in the box provided for the name. If deceased, so indicate.

NAME Residence Address (include Zip Codes) Telephone (include area code)

Father Home

Occupation

Work

Age

Mother Home

Mother’s Maiden Name

Occupation

Work

Age

Stepfather Home

Occupation

Work

Age

Stepmother Home

Occupation

Work

Age

Father-in-law Home

Occupation

Work

Age

Mother-in-law Home

Occupation

Work

Age

Brother Home

Occupation

Work

Age

Brother Home

Occupation

Work

Age

Brother Home

Occupation

Work

Age

Sister Home

Occupation

Work

Age

Sister Home

Occupation

Work

Age

5

Family Members and Relatives (Continued)

Sister Home

Occupation

Work

Age

Stepbrother Home

Occupation

Work

Age

Stepbrother Home

Occupation

Work

Age

Stepsister Home

Occupation

Work

Age

Stepsister Home

Occupation

Work

Age

List six other relatives (uncles, aunts, cousins, etc.) Name

Relationship

Home

Occupation

Work

Age

Name

Relationship

Home

Occupation

Work

Age

Name

Relationship

Home

Occupation

Work

Age

Name

Relationship

Home

Occupation

Work

Age

Name

Relationship

Home

Occupation

Work

Age

Name

Relationship

Home

Occupation

Work

Age

6

Family members and relatives (continued)

Children

List all of your children (include step-children, adopted children, etc.) Name Sex Relationship to you Living with you

M F Date of Birth Age

Natural Step Adopted Foster Yes No

Have any of your children ever been the subject of a C.H.I.N.S. petition or a MGL CH 119, sec. 51A investigation? Yes No

If you answered yes to the above question, a required written response must be attached. Your response must include dates, individuals, allegations, organizations/agencies and courts involved. Also include the current status or final outcome of the incident.

Marital Status

Single Married Widowed Separated Annulled Divorced Full name of spouse

Maiden name or any other names used

Date of birth

Age

Date of Marriage

Place of Marriage (city, county, state and country)

Spouse’s employer Occupation or position How long employed

Current address of spouse, if not living with you

Home phone Work phone

If divorced, widowed or had an annulment, provide the following information.

Full name of former spouse


Date of birth

Age

Date of Marriage


Former spouse’s employer Occupation or position How long employed

Current address of former spouse or last known address


Date filed for divorce/annulment

Court, city, county and state of divorce/annulment

Is divorce final?

Yes No

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Marital status (continued)

Full name of former spouse


Date of birth

Age

Date of Marriage


Former spouse’s employer Occupation or position How long employed

Current address of former spouse or last known address


Date filed for divorce/annulment

Court, city, county and state of divorce/annulment

Is divorce final?

Yes No Have you ever been ordered or agreed to pay child support? Yes No Have you ever been ordered or agreed to pay alimony? Yes No Have you ever been delinquent in child support payments or alimony payments? Yes No If you answered yes to any of the preceding three questions, you must attach a required written response. Please be specific in regards to dates, amounts, individuals and the court or government agency involved. You must also include the current status or final outcome of the incident.

Residences

List all of your residences during the last ten years. Begin with your most current residence. List entire address. Include unit number or apartment number, where applicable. You must include residences while in the military and while at school. Current address

City, state, and zip code Since (mo/yr)

With whom do you live If renting, give name, complete address, and phone number of person who collects the rent Address

City, state, and zip code From (mo/yr) To (mo/yr)

With whom did you live If rented, give name, complete address, and phone number of person who collected the rent Reason for moving Address


With whom did you live If rented, give name, complete address, and phone number of person who collected the rent Reason for moving

8

Residences (continued) Address










With whom did you live If rented, give name, complete address, and phone number of person who collected the rent Reason for moving

9

Residences (continued) Address






With whom did you live If rented, give name, complete address, and phone number of person who collected the rent Reason for moving List those individuals (roommates) with whom you have resided during the last ten years, excluding family members. Full name

Age Home phone Work phone

Current address

Occupation Years known

Full name


Current address


Full name


Current address


Full name


Current address


Full name


Current address


10

Residences (continued) Have you ever been evicted from a rental property? Yes No Have you ever been forced to surrender a security deposit on a rental property? Yes No Have you ever been late on a rent or mortgage payment? Yes No If you answered yes to any of the preceding three questions, you must provide a required written response. Be specific with regards to dates, locations, individuals, amounts and actions taken. If you have visited, resided in, been deployed to, or for any reason spent time in a foreign country, you must provide the following information.

Country From (mo/yr)

To (mo/yr)

Reason

Education

The Commonwealth of Massachusetts requires a police officer to possess a US high school diploma or its equivalent. Please indicate your current status with this requirement. Check all boxes that apply.

I posses a high school diploma from a US institution.

I passed the GED test meeting the required scores.

I possess a two-year college degree from an accredited college.

I possess a four-year degree from an accredited college or university.

I possess a postgraduate degree from an accredited college or university.

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Education (continued) During your background investigation, persons who have known you in a learning environment may be contacted. A review of your school records may be made in conjunction with those contacts.

Name and address of high schools attended and/or graduated from

From (mo/yr) To (mo/yr) Did you graduate

Yes No

Yes No

If you have successfully completed a General Equivalency Diploma Examination (GED), provide the following information. Location of examination

Date

Have you ever attended college? Yes No If yes, list all colleges and universities attended including postgraduate.

Name of college or university City and state Major From (mo/yr) To (mo/yr) Type of degree earned

Have you ever attended a trade, vocational, or business school? Yes No If yes, please provide the following information.

Name of school (include city and state) Type of school or training Dates attended Did you finish the course?

Yes No

Yes No

Yes No

Have you ever been dismissed, suspended or expelled from any high school, college, university or other educational institution? Yes No Have you ever been placed on scholastic/academic probation? Yes No Have you ever been the subject of any type of discipline imposed by a student judicial board or its equivalent? Yes No Have you ever committed plagiarism? Yes No Have you ever assisted another or received assistance from another during an examination? Yes No If you answered yes to any of the preceding five questions, you must attach a required written response. Be specific in regards to dates, institutions, individuals and actions taken. List all awards, honors, citations, positions held in school organizations, athletic endeavors, and any special recognition you received while attending school.

12

Education (continued)

Indicate your proficiency in each phase of each foreign language as “none”, “slight”, “good”, or “fluent”.

Language Speaking Ability Understanding Speech Reading Ability Writing Ability Spanish

Portuguese

French

Vietnamese

Chinese

English

Russian

German

Other (list)

Military

Note: If you have served in the military of any foreign nation, please provide all pertinent information. You may use one of the sections below. Did you comply with the draft registration law? Yes No Selective Service number

Have you ever served on active duty in any of the Armed Forces of the United States? Yes No Branch

Unit Occupation Enlistment date Discharge date

Service number

Highest rank attained Rank at discharge Type of discharge

Reason for separation

If active, list unit location, phone number and commanding officer’s name

Are you now or were you ever a member of any branch of the United States Military Reserve Forces? Yes No Branch


Service number



If current reserve, list unit location, phone number and commanding officer’s name

Have you ever served as a member of the National Guard of any State? Yes No Branch


Service number



If current member, list unit location, phone number and commanding officer’s name

13

Military (continued) Do you have any current or future military commitments? Yes No If yes, please list anticipated dates and locations.

Were you ever investigated for any criminal activity while in the military, National Guard or military reserves? Yes No Have you ever been reduced in pay grade or been the subject of any judicial or non-judicial disciplinary action while in the military. National Guard, or military reserves. Yes No If you answered yes to either of the preceding questions, you must attach a required written response. You must be specific in regards to dates, location, individuals, charges and actions taken. Did you receive an honorable discharge? Yes No If you received a discharge other that honorable, please explain. Starting with the most recent, list all duty stations (include basic training, tours overseas, etc.) while in the military.

From (mo/yr)

To (mo/yr)

Location Unit Duties/purpose

List all awards, medals, citations, decorations and special recognition you received while in the military.

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Employment

Beginning with your most current employment, list every job, including military service. Account for all time periods. The definition of “jobs” includes full-time employment, self-employment, part-time jobs, summer jobs, temporary work, volunteer work, and internships. You must list all employment regardless of the length of employment. List actual work addresses, not corporate office addresses. Addresses must be complete and accurate. Zip codes are required. If you have periods of unemployment, list those periods in sequence in the spaces specifically provided. Do you object to our contacting your present employer(s) prior to your being accepted? Yes No If yes, please explain. Has any employer or prospective employer (other than a Law Enforcement Agency) ever investigated your background? Yes No If yes, provide the following information.

Investigating Organization Name of investigator Result of investigation Date of investigation

Dates of employment

Name of employer Work Phone

From (mo/yr)

To (mo/yr)

Complete Address

Length of employment

Work schedule (for example: Monday-Friday, 9 to 5, etc.)

Current employment Job title or position Full time Part-time

Volunteer Internship

Temporary

Salary

Describe your duties Reason for leaving (be specific) Immediate supervisor’s name

Work phone or home phone (indicate which)

List another supervisor


List a co-worker


Unemployed From: ___________ To: ____________ If you collected unemployment benefits, list the office.

15

Employment (continued)

Dates of employment


From (mo/yr)

To (mo/yr)

Complete Address





Temporary

Salary





List a co-worker



Dates of employment


From (mo/yr)

To (mo/yr)

Complete Address





Temporary

Salary





List a co-worker



16


Dates of employment


From (mo/yr)

To (mo/yr)

Complete Address





Temporary

Salary





List a co-worker



Dates of employment


From (mo/yr)

To (mo/yr)

Complete Address





Temporary

Salary





List a co-worker



17


Dates of employment


From (mo/yr)

To (mo/yr)

Complete Address





Temporary

Salary





List a co-worker



Dates of employment


From (mo/yr)

To (mo/yr)

Complete Address





Temporary

Salary





List a co-worker



18


Dates of employment


From (mo/yr)

To (mo/yr)

Complete Address





Temporary

Salary





List a co-worker



Dates of employment


From (mo/yr)

To (mo/yr)

Complete Address





Temporary

Salary





List a co-worker



19


Dates of employment


From (mo/yr)

To (mo/yr)

Complete Address





Temporary

Salary





List a co-worker



Dates of employment


From (mo/yr)

To (mo/yr)

Complete Address





Temporary

Salary





List a co-worker



20


Dates of employment


From (mo/yr)

To (mo/yr)

Complete Address





Temporary

Salary





List a co-worker



Dates of employment


From (mo/yr)

To (mo/yr)

Complete Address





Temporary

Salary





List a co-worker



21


Dates of employment


From (mo/yr)

To (mo/yr)

Complete Address





Temporary

Salary





List a co-worker



Dates of employment


From (mo/yr)

To (mo/yr)

Complete Address





Temporary

Salary





List a co-worker



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Employment (continued) Has an employer ever treated you unfairly? Yes No Have you ever held employment under another name? Yes No Have you ever been terminated (fired) or asked to resign in lieu of termination? Yes No Have you ever been investigated by your employer for improper conduct, illegal activities, sexual harassment, or equal employment violations? Yes No Have you ever been suspended by an employer, or received a formal written reprimand, or verbal warning, or verbal counseling? Yes No Have you ever left an employment under unfavorable circumstances? Yes No Have you ever, or has it ever been determined you, committed one of the following acts: Stealing from an employer? Yes No Lied to an employer about the numbers of hours you worked? Yes No Been paid for hours that you did not work? Yes No Reported for work under the influence of drugs or alcohol? Yes No Fought physically or verbally with other workers? Yes No Had an accident while working? Yes No If you answered yes to any of the preceding questions, you must attach a required written response. Be specific in regards to dates, organizations, individuals and actions taken. List any awards or special recognition you have received during the course of your work history (do not include military service).

Law Enforcement Applications

Have you ever tested/applied for any position with a local, state, county or federal law enforcement agency? Yes No If yes, list EVERY agency you have applied with. Start with the most recent. Give complete, accurate addresses. All agencies MUST be listed regardless of the outcome or current status. Check all boxes that apply for each agency. Name of agency

Date applied

Complete address

Position

Submitted application only Took written test Failed written test Background investigation conducted Background investigation failed Oral interview taken Failed oral interview Polygraph taken Polygraph failed Placed on eligibility list Disqualified Was not selected Hired/job offer made No response from agency Withdrew application or declined offer What was your background investigator’s name and phone number?

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Law Enforcement Applications (continued) Name of agency

Date applied

Complete address

Position

Submitted application only Took written test Failed written test Background investigation conducted Background investigation failed Oral interview taken Failed oral interview Polygraph taken Polygraph failed Placed on eligibility list Disqualified Was not selected Hired/job offer made No response from agency Withdrew application or declined offer What was your background investigator’s name and phone number? Name of agency

Date applied

Complete address

Position


Date applied

Complete address

Position


Date applied

Complete address

Position

Submitted application only Took written test Failed written test Background investigation conducted Background investigation failed Oral interview taken Failed oral interview Polygraph taken Polygraph failed Placed on eligibility list Disqualified Was not selected Hired/job offer made No response from agency Withdrew application or declined offer What was your background investigator’s name and phone number?

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Law Enforcement Applications (continued) Have you ever attended a training academy for any local, county, state, or federal law enforcement agency? Yes No If yes, please provide the following information. Name and address of academy

Date Started

Date ended

Was the training full-time part-time

Type of certification

Have you ever been a police cadet or explorer? Yes No If yes, please provide the following information.

Agency name and address Date started Date ended

Motor Vehicle Operation

Do you possess a valid driver’s license issued by the Commonwealth of Massachusetts? Yes No If yes, please provide the following information. License number Expiration date

Have you ever applied for, been issued, or obtained a driver’s license or state identification card under a different name, date of birth or license number? Yes No If yes, please explain. Give state, dates, reason, and outcome. List other states where you are, or have been, licensed to operate a motor vehicle.

State Name under which license was issued License number Expiration date

Has your driver’s license or right to operate ever been suspended, revoked, or been placed on negligent operator’s probation by any state or governmental agency? Yes No If yes, please explain. Give state, dates, reason and outcome.

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Motor Vehicle Operation (continued) List all vehicles that you own.

Year Make/Model Color Registration number and state Is the vehicle currently

registered?

Is the vehicle currently insured?

Massachusetts law requires that drivers and owners of vehicles be covered by automobile liability insurance. Please list your insurance company. Insurance company

Local agent and phone number Policy number Expiration date

Have you ever received a written motor vehicle citation (or written warning) from a police officer? Yes No If yes, please list all traffic citations and written warnings. Month/Year Violation(s) City and state Agency that issued citation What action resulted? (Fined, dismissed, traffic school)

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Motor Vehicle Operation (continued) As a driver, have you ever been involved in a motor vehicle accident? Yes No If yes, please provide the following information. Date

Location of accident (include city and state)

Police agency that took the report

Were you at fault? Yes No Was there a police report taken? Yes No Did the accident cause injury to another person? Yes No Were you cited or arrested? Yes No Was the accident a hit and run? Yes No

Date




Date




Date




Date




Do you now or have you ever owed money for traffic fines? Yes No Do you now or have you ever owed money for parking tickets? Yes No If you answered yes to either of the preceding questions, you must attach a required written response. Please be specific with regards to dates, agencies, amounts and final outcome.

27

Legal

An applicant for employment may answer “no record” on the following question if any of the following circumstances are applicable: you have never been arrested, you have been arrested but never been tried for a criminal offense, you have been tried for a criminal offense but never convicted, you have a first conviction for any of the following misdemeanors, a) drunkenness b) simple assault c) speeding d) minor traffic violations e) affray f) disturbance of the peace, you have not been convicted of an offense within the five years before the date of this application and/or you have been convicted of misdemeanors where the date of conviction or the completion of any period of incarceration resulting there from, whichever date is later, occurred five or more years prior to the date of this application. (See MGL CH. 151B sec. 4) An applicant for employment with a sealed record on file with the Commissioner of Probation may answer “no record” with respect to any inquiry herein relative to prior arrests, criminal court appearances, or convictions. In addition, any applicant for employment may answer “no record” with respect to prior arrest, court appearances and adjudication in all cases of delinquency or as a child in need of services, which did not result in a complaint transferred to the Superior Court for criminal prosecution. (See MGL CH. 276 sec. 100a & sec. 100c) Have you ever been arrested or arraigned for a criminal offense? Yes No To the best of your knowledge are you currently, or have you ever been, under investigation by any local, state, county, federal or foreign law enforcement agency? Yes No Have you ever had an emergency, temporary, or permanent protective order issued against you under the provisions of the following statutes: MGL CH. 208 sec. 18, 34B, 34C (Divorce) Yes No MGL CH. 209 sec. 32 (Abandonment in Marriage) Yes No MGL CH. 209A, sec. 3, 4, 5 (Abuse Prevention) Yes No If you answered yes to any of the preceding questions, you must attach a required written response. Please be specific in regards to dates, courts, individuals, charges, circumstances, current status, and final disposition.

Are you now or have you ever been involved as a plaintiff or defendant in any civil court, land court or small claims action? Yes No Do you have knowledge of any forthcoming civil suits in which you will be either a plaintiff or defendant? Yes No If yes to either question, please provide the following information. Date

Court

Docket number

Plaintiff Defendant

Details Date

Court

Docket number

Plaintiff Defendant

Details

28

Finances

Are you currently indebted to anyone (individually, jointly, or as a guarantor)? Yes No If yes, please provide the following information regarding all open charge accounts, loans, financial contracts and long-term liabilities.

Name of creditor, bank, firm or lender Reason for debt Monthly payment

Current balance

List the number of times you have been

late thirty days or more

Have you, or has a company in which you controlled a significant proprietary interest, ever filed for bankruptcy, been subject to a tax lien, or had a legal judgment rendered against you/it for a debt? Yes No Have you ever been delinquent on any local, county, state or federal tax liabilities? Yes No Have you ever had your wages attached or garnished? Yes No Have you ever had any of your bills, accounts, or loans turned over to a collection agency? Yes No Have you ever had any purchased goods, vehicles, property or items repossessed (includes voluntary repossessions)? Yes No Have you ever been refused credit? Yes No If you answered yes to any of the previous questions, you must attach a required written response. Please be specific in regards to dates, amounts, agencies/companies, creditors, courts, type of action and final outcome. List all sources of income other than your present employment.

Source of income Monthly amount

29

Finances (continued) List any real property in which you, your spouse, or your minor children have an equity or financial interest.

Property address Owner Describe interest

Licenses

Have you ever been issued a firearms license, firearms identification card, license to carry a firearm, concealed carry permit or firearms permit of any type? Yes No If yes, please provide the following information.

Type of license License number Reason for issue Date of issue Location where issued

Have you ever applied for and been denied a firearms license, firearms identification card, license to carry a firearm, concealed carry permit or firearms permit of any type? Yes No Has your firearms license, firearms identification card, license to carry a firearm, concealed carry permit or firearms permit of any type ever been suspended or revoked? Yes No Have you been forced to surrender your firearms license, firearms identification card, license to carry a firearm, concealed carry permit or firearms permit of any type for any reason, including the issuance of a protective order? Yes No If you answered yes to any of the preceding questions, you must attach a required written response. Please be specific in regards to dates, locations, individuals, courts, agencies, actions taken, and final outcome.

Have you ever been issued a Hackney License? Yes No If yes, please provide the following information.

City or town of where issued Date issued

30

Licenses (continued) Have you ever had a Hackney license denied, revoked or suspended? Yes No If you answered yes to the previous question, you must attach a required written response. Please be specific in regards to dates, locations, agencies, and reason for denial/suspension/revocation. Are you currently an owner, partner, or investor in any business enterprise that requires a federal, state, county, or city permit/license to operate? Yes No If yes, please provide the following information.

Name of business Complete address Agency that issued permit/license Type of permit/license

Have you ever applied for a bond or a job that requires a bond? Yes No If yes, please provide the following information.

Position Employer Address Date

General Behavior

Have you ever used possessed, supplied, or manufactured any of the following substances? Marijuana, hashish, cocaine, PCP, methamphetamine, psilocybin, LSD, heroin, morphine, steroids, or any other illegal drug. Yes No Have you ever used, possessed, supplied or manufactured any prescription drugs without a prescription? Yes No If you answered yes to either of the preceding questions, you must attach a required written response. Please be specific in regards to the date, location, type of drug and how it was administered. Each individual use of a drug must be detailed. Have you ever been in a fight after having recently consumed drugs or alcohol? Yes No Have you ever been in an accident after having recently consumed drugs or alcohol? Yes No Have you ever been taken into protective custody? Yes No If you answered yes to any of the preceding questions, you must attach a required written response. Please be specific in regards to dates, locations, agencies involved and actions taken.

Do you now, or have you ever gambled? Yes No If yes, you must answer all the following questions.

Amount spent on gambling in a year

Largest sum won while gambling

What types of gambling have you participated in (check all that apply)? Horse track Dog track State lottery Casino games Football cards Professional or college sports Card games Scratch tickets Other (list)

Largest sum lost while gambling

Number of times a year that you gamble

31

General behavior (continued)

Have you ever borrowed money to cover a gambling debt or to continue gambling? Yes No Have you ever, or do you presently, have an outstanding gambling debt? Yes No If you answered yes to either of the preceding questions you must attach a required written response. Please be specific in regards to dates, amounts, and individuals.

Are you now or have you ever been a member of any club, society, professional association or organization? Yes No If yes, please provide the following information.

Organization Address Positions held Dates

Are you now, or have you ever been, a member of any foreign or domestic organization, association, movement, group, or combination of persons which is totalitarian, fascist, communist or subversive, or which has adopted, or shows a policy of advocating or approving the commission of acts of force or violence to deny other persons their rights under the Constitution of the United States, or which seeks to alter the form of the government of the United States by unconstitutional means? Yes No If yes, please explain fully.

Do you object to wearing a uniform? Yes No Do you object to working nights and weekends? Yes No Do you foresee any conflict of interest between your personal habits/beliefs and the role of a police officer with the Truro Police Department? Yes No If yes to any of these questions, please explain fully below.

32

References

Please list as references four individuals you have known for at least two years who have knowledge of you and your qualifications. DO NOT include relatives, family members, current or former employers or current fellow employees. All persons whom you list may be asked to appraise your character, ability, experience, personality and other qualities. Complete address information including zip code must be listed. Name

Mailing Address Years Known Age

Occupation

Home Address Home phone number

Relationship

Work Address Work phone number

Name


Occupation


Relationship


Name


Occupation


Relationship


Name


Occupation


Relationship


33

Required written response

You may use this page for any required written response or to provide any additional information or explanations to any of the questions in this form. Please make enough photocopies of this page for your needs. A separate sheet for each question or response should be prepared and then placed in sequence within the Personal History Form. All responses should be labeled to correspond with the question being answered.

34

Written communication

In 200-300 words, handwrite on this page your response to the following topic: Why I want to be a police officer for the Town Of Truro. Signature: _________________________________ Date: _______________________

35

Written communication (continued) In 200-300 words, handwrite on this page your concept of community policing and why you want to be a Truro Police Officer. Signature: _________________________________ Date: _______________________

PLEASE READ THE FOLLOWING CAREFULLY AND SIGN BELOW INDICATING THAT YOU UNDERSTAND AND AGREE TO THE TERMS AS STATED.

I understand that a physical, which includes a drug screening urinalysis, may be required after an employment offer has been made. I understand that this is not a contract of employment and I or the municipality may sever the employment relationship at any time for any reason. Any oral or written statement to the contrary, including any which are m ade by a City/Town representative, are disavowed and may not be relied upon by any prospective or existing employee. I understand also that this Department has established day and night tours for which I must be available as required. I further understand that any appointment tendered me will be contingent upon the results of a complete character and fitness investigation, and I am aware that willfully withholding i nformation or making false statements on this application will be the basis for rejection of my application or dismissal from the Department. I agree to these conditions and I hereby certify that all statements made by me on this application are true and complete to the best of my knowledge. I hereby give the this Police Department authorization to conta ct any perso n reasonably related to th e character and fitness investigation and to request that an independent credit report be prepared as to my financial condition. I also authorize any person contacted to share written and oral information which is reasonably related to the public safety position for which I am applying. Finally, I hereby release, discharge and exonerate this municipality, its agents and representatives, and any person furnishing or receiving information, from any and all liability of every nature and kind arising out of the furnishing or inspection of such documents, records, or other information or investigations made by or on behalf of this municipality. This authority shall continue until revoked in writing by the undersigned. Date Signature of Applicant

COMMONWEALTH OF MASSACHUSETTS , SS.

I, , being duly sworn, depose and state I am the above

named person. I signed the foregoing statement. I personally read and printed by hand or

typewriter/printer 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.

Signature of Applicant Sworn before me this day of , .

Notary Public My Commission Expires:

GENERAL RELEASE

Date:

I, , born at on , having filed an application for a position with the Truro Police Department, consent to have an investigation made as to my mor al character, reputation and fitness for the position to which I have applied. I al so agree that such information as may be received, reported to and reviewed by the appointing authority. I agree to give any fu rther information which may be required in reference to my past record. I also authorize and request every person, firm, company, corporation, governmental agency, court, association or institution having control of any documents, records and other information pertaining to me, to furnish to the Truro Police Department any such information, including, documents, records, files regarding charges or complaints filed against me, formal or informal, pending or closed, or any other pertinent data, and to permit the police department or any of its agents or representatives to insp ect and make copies of such documents, records and other information.

Specifically, in addition, I hereby authorize the release of the following data or records to the Truro Police Department: I hereby release, discharge and exonerate the Truro 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 or inspection of such documents, records and other information or the investigations made by or on behalf of the Truro Police Department. This authority shall continue for one year unless sooner revoked in writing by the undersigned. Signed








mwheeler

Typewritten Text

CREDIT CHECK AUTHORIZATION

The undersigned applicant certifies that he/she has duly authorized this credit check, and he/she acknowledges that all in formation requested is for the exclus ive, official use of the undersi gned police department and for use only in connection wit h such investigation; and the consumer r eport requested is for a permissible purpose under the Fair Credit Reporting Act, of which the undersigned is knowledgeable.

Pursuant to the provisions of the Fair Credit Repor ting Act, any person who knowingly and willfully obtains information from a consumer reporting agency under false pretenses shall be fined not more t han $5000 or imprisoned for not more than one year, or both. In addition, similar rights are prov ided under applic able Massachusetts general Laws. You should k now that an inv estigative consumer report commonly inc ludes information as to the consumer’s character, general reputation, personal characteristics, and mode of living. The Truro Police Department may request a consumer credit report on you. You have the right to request a copy of the report. Applicant Police Department Employee RequestingThis Report Title TRURO POLICE DEPARTMENT Reference: M.G.L. c. 93 § 53 Title 15 USC 41 § 168 1b (appendix)

CORI CHECK ACKNOWLEDGMENT I, residing at

, acknowledge that a Criminal Offender Record

Information (CORI) check will be performed as part of the municipality’s hiring process.

I further acknowledge that a refusal to allow the CORI check to be performed will cause

my application to no longer be considered for employment.

Signature








Form Approved 0MB No. 0960-0566

Social Security Administration Consent for Release of Information TO: Social Security Administration Name ______________________ Date of Birth ___________ Social Security Number______________ I authorize the Social Security Administration to release information or records about me to:

Truro Police Department, 344 Route 6, PO Box 995, Truro, MA 02666-0995 (508) 487-8730 I want this information released because: I am an applicant for a position with the Truro Police Department, and subject to a full background investigation. (There may be a charge for releasing information.) Please release the following information: — Social Security Number — Identifying information (includes date and place of birth, parents’ names) — Monthly Social Security benefit amount — Monthly Supplemental Security Income payment amount — Information about benefits/payments I received from to _______ — Information about my Medicare claim/coverage from to _______

(specify) — Medical records — Record(s) from my file (specify) — Other (specify) I am the individual to whom the information/record applies or that person’s parent (if a minor) or legal guardian. I know that if I make any representation which I know is false to obtain information from Social Security records, I could be punished by a fine or imprisonment or both. Signature: (Show signatures, names, and addresses of two people if signed by mark.) Date:_______________ Relationship:________________________________ SSA-3288 Internet (12/99)

MEDICAL CERTIFICATION

The below-named individual has applied for the position of Truro Police Officer. Part of our prescreening process is a fitness assessment. As it is not this department’s desire to conduct any type of testing that may cause any personal harm to the applicant or to assume any liability for any such harm, we are requesting your assistance in determining this applicant’s ability to safely complete all phases of this fitness assessment. To that end, a brief description of the test is given below with a portion at the end that calls for your professional assessment of the individual’s ability to safely complete all phases.

MUSCULAR STRENGTH AND ENDURANCE TESTS

• HANDGRIP: This test measures grip strength. The individual will grasp a handle connected to a recording device and exert a single maximal contraction. Three trials will be given.

• SIT-UPS: This test measures the strength of the abdominal muscles. The individual will perform sit-ups, as fast as possible, for a specific time period (e.g., 1 minute). One trial will be given.

• ARM ENDURANCE: This test measures the endurance of muscles of the upper body. The individual will crank an Arm Ergo meter, as fast as possible, for a specific period of time (e.g. 2 minutes).

• ARM PRESS/BENCH PRESS: The purpose of this test is to determine the maximum force that can be generated by the upper body muscles. This test involves lying on one’s back and extending a weighted bar with the arms to full elbow extension followed by lowering the bar to chest level and returning to full elbow extension.

FLEXIBILITY

• SITAND REACH: Th is test measures the flexibility of the lower b ack and muscles of the posterior thighs (hamstrings). Three trials will be given.

JOB SIMULATIONS

• PURSUIT/RESTRAIN SIMULATION: The pursuit/restrain simulation is designed to represent chasing and subduing a suspect and contains a series of tasks that lead up to and include a simulated restraint of a suspect. Tasks performed in the simulation include essential physical tasks performed by troopers on the job. Examples of these tasks are exiting the vehicle, running on flat areas a nd stairs, eva ding obstacles (e.g., branches, punches), bending/stooping, negotiating barriers (e.g., guardrail), and restraining (e.g., handcuff, hold) resistive individuals.

• RESCUE SIMULATION: The rescue simulation is designed to represent exiting a vehicle, moving quickly to accident scene, and rescuing/removing a passive/unconscious person. Tasks performed in the simulation include essential physical tasks performed by troopers on the job. Examples of these tasks are exiting the vehicle, running on flat areas and stairs, negotiating median barrier, and dragging victim to safety.

CANDIDATE’S NAME________________________________________________

Can this Candidate safely perform all phases of the above fitness assessment? (YES ______NO ______)

____________________________________ _ ______ ____________________________

(PRINT DOCTOR’S NAME) (DOCTOR’S SIGNATURE)

____________________________________ _ ___________________________________

(DOCTORS ADDRESS) (DATE)

____________________________________

(DOCTORS TELEPHONE)

NOTICE

PENSION REFORM COMMUNIT1ES

TO POLICE OFFICER AND FIRE FIGHTER CANDIDATES

Please be advised that you must meet Health and Physical Fitness Standards while employed in order to maintain your employment. Every two years, you will be required to undergo a health and physical fitness assessment. This assessment will consist of a job related physical fitness test designed to simulate the physical demands of the duties that may be performed by police officers or fire fighters, and an assessment of your overall health as it relates to your ability to perform the essential functions of your job. In order to assist you in meeting these standards, wellness programs will be made available to you that will provide you with information on maintaining your physical fitness and overall health and provide an assessment of key health indicators such as blood pressure and cholesterol levels. These standards are m andated by the provisions of Section 22D of Chapter of Chapter 32 of the Massachusetts General Laws, as amended by Chapter 697 of the Acts of 1987.

_________________________________ Name of Applicant _________________________________ Signature of Applicant

COMMONWEALTH OF MASSACHUSETTS

, SS.


named person. I signed the foregoing statement. I personally read and printed by hand or typewriter/printer 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.



To the Applicant: The screening process s hall be conducte d according to t he following criteria under the direction of the Chief of Police. All applicants shall be notified in writing of the content and procedures involved in the screening process, the screening process duration, and the policy on retesting, reapplication, and reevaluation of applicants that are not appointed. The process shall include, but is not limited to the following:

A review and screening of applicants and documentation will be conducted by the Chief of Police, and/or

his designee.

An initial interview may be conducted by the Chief of Police, and/or his designee. A thorough background check is to be conducted by officers trained in background investigation

techniques, which includes: verification of qualifying credentials; review of any criminal record; interviews with neighbors; interviews with past and p resent employers; checking on three personal references provided by the applicant; utilization of the police candidate background self report kit, and a check of the applicant’s credit.

A formal interview of the applicant, using valid, useful, and non-discriminatory procedures, shall be

conducted and comprised of members designated by the Chief of Police.

An initial medical examination, consisting of a t hrough and job-related medical examination, will be conducted by a physician selected by the department. This applies only to full-time applicants and part-time police officer applicants.

A psychological exam administered by a qualified professional selected by the Town of Truro will be given

to all applicants for full-time employment and may be administered to part-time applicants.

If not academy trained, the Cr iminal Justice Training Council will administer a physical fitness/physical abilities test e xamination, (PAT Test) using a jo b simulation test. Th is applies only to full-time police officer applicants.

An applicant who fails the initial physical examination will be notified by the Chief of Police, or his designee. An applicant who passes/fails the physical agility test wil l be notified at the test site. In order for an applicant to be considered for student officer status (police candidates only), they must successfully pass all physical, psychological, and medical examinations. No applicant will be allowe d to pa ss on to the ne xt step until successfully completing the previous step. If an applicant fails a step in the process he shall be given a reasonable opportunity to correct or rectify t he deficiency, and if successful, allowed to continue the screening process. Notification of failure must be made in writing to the applicant as soon as possible. Such examinations are to be provided at no cost to the applicant.

HIRING PROCESS STATEMENT

I understand that if I am appointed to t he Truro Police Departm ent, I am subject to the rules an d regulations of both the Truro Police Department and the Town of Truro.

I understand that a background investigation will be conducted by the Truro Police Department, including but not limited to: education, em ployment, friends, cri minal records, driving history, relatives, military service, neighbors, credit rating, and any other area deemed necessary by the Chief of Police.

I understand that I must be available for interviews and oral boards as required by the Chief of Police.

I understand that I may be required to furnish th e Truro Police Department with any additional information as required by the Chief of Police.

I understand that I will be required to undergo psychological evaluation tests conducted by a psychologist selected by the Truro Police Department.

I understand that I will be required to participate in a complete medical examination by a medical doctor selected by the Town of Truro, including a dr ug screen, laboratory and other tests, to deter mine my physical fitness to serve as a police officer or Telecommunicator in the Town of Truro.

I understand that I must complete the requirements listed above, as well as other requirements set forth by the Truro Pol ice department successfully and within a specified time. I also understand that if I fail t o meet these or any other requirements successfully and within the specified time, my name will b e withdrawn from consideration as a police officer or Telecommunicator in the Town of Truro, or if already employed, my employment as a police officer or Telecommunicator, will be term inated, subject to the rules and regulations of the Town of Truro. I have read the above statement and understand its provisions.

_________________________________ Signature of Applicant


, SS.




every respect.



NOTICE OF PROHIBITION OF TATTOOS AND BODY PIERCINGS

TO POLICE OFFICER AND TELECOMMUNICATOR CANDIDATES

I understand that employees of the Truro Police Department shall not display any tattoos, or body pierced jewelry, while in uniform or on duty.

_________________________________ Name of Applicant _________________________________ Signature of Applicant


, SS.




every respect.

