Norman Department Personnel History Statement Packet

Applicant Name (First, Middle, Last)

1 SELECTION STANDARDS-NORMAN POLICE DEPARTMENT

The attached information contains the Norman Police Department’s (NPD) Minimum Selection Standards and your Personnel History Statement (PHS) packet. It is very important that you review this information carefully and understand its contents. If you do NOT meet one or more of the standards, you should decline further consideration for a position with the Norman Police Department at this time. Your current disqualification may not keep you from applying in the future, as many situations may remedy themselves over time

Please Note: All Candidates must completely fill out the PHS packet. An Applicant’s failure to submit a completed PHS packet will result in disqualification from the NPD hiring process. Be certain to attach photocopies of your driver’s license, and social security card.

In addition to the employment application and PHS document, applicants will be required to submit the following certified or original documents: high school and college transcripts, birth certificate, DD Form 214. Xerox copies ARE NOT acceptable; we require either certified or original documents. If you give us your only original document(s), you can request these documents back at the end of the process.

INSTRUCTIONS TO THE APPLICANT

The information you provide in this Personal History Statement (PHS) Packet will be used in the investigation into your background, which will assist in determining your suitability for the position of Police Officer. Please fill out this PHS completely and accurately. Keep in mind that:

1. The completion of this questionnaire is mandatory. 2. All statements are subject to verification. 3. Deliberate inaccuracies or omissions may bar or remove you from further testing and employment. 4. All time periods in your background must be accounted for. 5. All information contained on the Personal History Statement and any information you provide will be reviewed with you during your pre-employment interview.

It is to your advantage to respond openly. Any negative factor in your background will be evaluated in terms of the circumstances and facts surrounding its occurrence, and its degree of relevance to the job you are applying for. For example, being fired from a job or having a misdemeanor record is not in itself grounds for disqualification. During the investigation, the investigator will inquire into the facts surrounding such an occurrence. An evaluation will then be made of the relevance of these facts to the requirements of the job.

You must list all and/or convictions even if you received a release or a pardon. You must also list the time(s) you were detained by the police for any reason. Document this information in the Criminal History section of this questionnaire.

2 SELECTION STANDARDS-NORMAN POLICE DEPARTMENT The Americans With Disabilities Act prohibits employers from making medically related inquiries prior to a conditional offer of employment. Therefore, if you are completing this personal history statement before you have received a conditional offer of employment, you do not have to provide information concerning physical or medical conditions, either past or current.

Please print in black ink or type your response on this PHS. If a question does not apply to you, write “N/A” (not applicable) in the space provided for your answer. If you need more space to respond to a question, use the continuation sheets provided and identify the additional information with the question number. MINIMUM STANDARDS .

1. UNITED STATES CITIZENSHIP IS REQUIRED FOR YOU TO BE HIRED. In order to apply, the applicant must be a U.S. citizen or if a non-citizen, the applicant must be a permanent resident alien, who in accordance with the requirements of the United States Citizenship and Immigration Service, is eligible and has applied for citizenship. United States citizenship is required at time conditional offer of employment is given to the applicant.

2. MILITARY RECORD: The applicant must have been discharged under honorable conditions (fair employment laws apply).

3. A valid Oklahoma State Driver’s License is required prior to your employment.

4. MINIMUM EDUCATION: High school Diploma or GED

5. TRAFFIC RECORD: An applicant’s driving record will be thoroughly assessed and may be a factor for disqualification.

6. CRIMINAL ACTIVITY: An applicant’s criminal record, including all arrests, prosecutions, deferred prosecutions, ‘nolo contendere’ , and non-conviction information will be thoroughly assessed and may be grounds for disqualification.

7. EMPLOYMENT: An applicant’s employment history, including any terminations, or leaving an employer in lieu of termination, will be thoroughly assessed and may be grounds for disqualification.

8. FINANCIAL: An applicant’s credit history, including excessive credit card debt or unresolved accounts in collection will be thoroughly assessed and may be grounds for disqualification. Failure to pay income tax or child support will be disqualifying.

9. LATERAL ENTRY CANDIDATES: An applicant for lateral entry is required to have:

A. Two (2) years prior full time law enforcement experience (in good standing) with

3 B. Law enforcement certification must be current or the applicant must have been employed as a full time peace officer for at least three (3) months within the two (2) year period immediately preceding the request for Oklahoma certification (out of state applicants) or submission of application for employment to this agency (Oklahoma CLEET Certified applicants).

C. If hired: Lateral Entry candidates will enter the academy at Pay Grade F25, Step 1: $51,705 up to Step 3: $55,924 and continue in the pay scale according to the agreement established between the City of Norman and the Fraternal Order of Police, Lodge No. 122

D. Lateral entry does not mean lateral rank, special team position guarantee, or supervisory position or responsibilities.

E. Lateral entry applicants must have the ability to testify in legal proceedings with no conflict in relation to U.S. Supreme Court Brady V. , 373 U.S. 83 (1963).

F. Part time, Military, Detention, Reserve Police Officer, Park Ranger/Park police, Capital police, Court security, Special District police, Railroad police, and Federal Law Enforcement personnel will NOT be considered as previous related experience.

4 Norman Police Department Disqualifiers

Please read the following disqualifiers carefully. If any of the following apply, you will not be qualified to participate in the hiring process. A polygraph will be given during the selection process using these same questions, as well as others. If you have any questions, please contact the Human Resources Department at (405)366-5482.

Under Chief’s Directive:

____ Any unlawful use of a controlled substance or illegal drug within the last five (5) years, prior to application submittal. This excludes marijuana and prescription medicine.

____ Any unlawful use or selling of a controlled substance within the last two (2) years prior to application submittal. This includes prescription medication and marijuana.

* Marijuana, whether it is used medically or recreationally, remains a violation of the Federal Controlled Substances Act, 21 U.S.C. §§ 801 et seq.

State Law

____ Applicant has a FBI or OSBI record of a conviction of a felony, a of moral turpitude,i or domestic violence. (70OS3311(E)(1),(a)(b)(J)(1)(a-b),(E)and(J)(5)(F)

____ Applicant has received a verdict of or entered a of nolo contendere, or is participating in a deferred sentence, for a felony, a crime involving moral turpitude or a domestic violence offense. (70OS3311(E)(1),(e) (J)(1)(c),and(J)(6)(F))

____ Applicant is subject to an order of the Council (CLEET) revoking, suspending, or accepting a voluntary surrender of their peace officer certification. (70OS3311 (E) (1), (f) (F))

____ Applicant has voluntarily surrendered and relinquished their peace officer certification to CLEET within five (5) years of the date of this application. (70OS3311 (J) (10) (a))

____ Applicant has had their police or peace officer certification from another state revoked or voluntarily surrendered within five (5) years of the date of this application. (70OS3311 (J) (1) (e), and ((J) (10) (b)

____ A psychologist licensed by the State of Oklahoma within one (1) year of application has found applicant unsuitable for employment or certification. (70OS3311 (E) (2) (a))

____ Applicant does not possess a high school diploma or a GED equivalency certificate. (70OS3311 (E) (1), (d)

____ Applicant is under 21, or more than 45, years of age prior to certification as an officer. (11OS50- 112(A)), and70OS3311 (E) (h))

5 ____ Applicant cannot provide proof of United States citizenship or resident alien status. (70OS3311 (E) (1) (i)

____ Applicant has willfully misrepresented information in an employment application, application to the Council (CLEET), records of , or in testimony under oath. (70OS3311 (J) (1) (d))

____ Applicant is currently undergoing treatment for a mental illness, condition or disorder. For purposes of this subsection, "currently undergoing treatment for mental illness, condition or disorder" means the person has been diagnosed by a licensed physician , psychologist, or licensed mental health professional as being afflicted with a substantial disorder of thought, mood, perception, psychological orientation or memory that significantly impairs judgment, behavior, capacity to recognize reality, or ability to meet the ordinary demands of life and such condition continues to exist. (70OS3311 (E) (1), (g) (J) (7))

____ Applicant has an interest, financial or otherwise, in a wrecker or towing service, or with a person or in a business that derives business or income from a wrecker or towing service. (47OS72 956(C)

Federal Law

____ Applicant has been convicted in any court of a crime punishable by imprisonment for a term exceeding one year. (18USC922 (g) (1))

____ Applicant is a fugitive from justice. (18USC922 (g) (2))

____ Applicant is an unlawful user to any controlled substance.ii (18USC922 (g) (3))

____ Applicant has been adjudicated as a mental defective or who has been committed to a mental institution. (18USC922 (g) (4))

____ Applicant, being an alien, is illegally or unlawfully in the United States; or has been admitted to the United States under a nonimmigrant visa.iii (18USC922 (g) (5))

____ Applicant has been discharged from the Armed Forces under dishonorable conditions. (18USC922 (g) (6))

____ Applicant, having once been a citizen of the United States, has renounced his citizenship. (18USC922 (g) (7))

____ Applicant is subject to a court order that restrains the applicant from harassing, stalking, or threatening an intimate partner or child of an intimate partner. (18USC922 (g) (8)) ____ Applicant has been convicted in any court of a misdemeanor crime of domestic violence. (18USC922 (g) (9))

By signing below, you are acknowledging that you have fully read and understand these disqualifiers and that none apply to you.

______/______Signature Date

6 SCREENING/SELECTION PROCESS

General Information: Applicants who successfully pass the written and physical ability testing, and do not meet disqualifying criteria will be assessed using a core stability rating process. The top scoring candidates will continue in the hiring process. The remaining steps in the process include the following: 1. Oral interview board 2. Background investigation. 3. Polygraph examination. 4. Psychological tests. 5. Medical examination.

Other Information: 1. Academic degrees are not required for appointment. 2. Academic incentive pay is applicable and consideration is given in competitive promotional examinations.

7 NORMAN POLICE DEPARTMENT PERSONAL HISTORY STATEMENT

I. IDENTIFYING INFORMATION In application for the position of: Name: (First) (Middle) (Last) Social Security No. List any other name, alias, or nickname by which you have been known. (including maiden name): Drivers License #: State: Date of Birth: Age : Height: Weight: Work Phone: Home Phone: Cell Phone: Email: Place of Birth (name of hospital): City, County or Town: STATE: List all scars, Identifying Marks, and ALL Tattoos (with location on body):

Are you a US citizen? Yes [ ] No [ ] If you are a naturalized citizen of the U.S., then fill out the information below and bring documentation to interview. ______Certificate Number Date Court City State Marital Status: Married [ ] Single [ ] Engaged [ ] Divorced [ ] Widowed [ ] Separated [ ] List Spouse’s Full Name (including maiden name): Do you have a preferred name of gender pronoun? If so, it is:

II. RESIDENCE RECORD Start with your present address and working back; list each address at which you have resided within the last ten years: Date of Occupancy Street City State Zip Code From To

8 III. FAMILY RECORD / HISTORY

List below all of your children; alive or deceased (include step-children): Name Date of Birth

Are you responsible for support payments: Yes [ ] No [ ] If yes, Explain

RELATIVES: List 1-Spouse or Domestic Partner, 2-Parents, 3-Guardians, 4-Step-parents, 5-Foster parents, 6-Parents-in-law, 7-Brothers, 8-Sisters, 9–Former Spouse/Domestic Partner (indicate relationship by number in square)

# Name Street Address City State Zip Home # Work #

IV. PERSONAL REFERENCES

List five adult references (not relatives, former or present employers) you have known for at least three years (preferably the past 3 years). It is very important that you list work phone numbers for all references. You may need a list of alternative references that can be supplied to your background investigator in the event some of the references cannot be contacted.

Yrs. Name Street Address City State Zip Home # Work #

9 V. EMPLOYMENT Begin with your most recent job. List your complete history for the past ten (10) years, including temporary or seasonal employment, and all periods of unemployment, schooling, or military service. LIST THE COMPLETE ADDRESS AND PHONE NUMBER OF THE EMPLOYER.

From: Name of Employer Address of Employer Phone No. Job Title To: Description of Duties Shift hours worked

Name of Supervisor and phone no.

Names of Co-workers Why did you leave?

From: Name of Employer Address of Employer Phone No. Job Title To: Description of Duties Shift hours worked

Name of Supervisor and phone no.

Names of Co-workers Why did you leave?

From: Name of Employer Address of Employer Phone No. Job Title To: Description of Duties Shift hours worked

Name of Supervisor and phone no.

Names of Co-workers Why did you leave?

From: Name of Employer Address of Employer Phone No. Job Title To: Description of Duties Shift hours worked

Name of Supervisor and phone no.

Names of Co-workers Why did you leave?

From: Name of Employer Address of Employer Phone No. Job Title To: Description of Duties Shift hours worked

Name of Supervisor and phone no.

Names of Co-workers Why did you leave?

10 V. EMPLOYMENT - CONTINUED From: Name of Employer Address of Employer Phone No. Job Title To: Description of Duties Shift hours worked

Name of Supervisor and phone no.

Names of Co-workers Why did you leave?

From: Name of Employer Address of Employer Phone No. Job Title To: Description of Duties Shift hours worked

Name of Supervisor and phone no.

Names of Co-workers Why did you leave?

From: Name of Employer Address of Employer Phone No. Job Title To: Description of Duties Shift hours worked

Name of Supervisor and phone no.

Names of Co-workers Why did you leave?

Have you ever been discharged, asked to resign, or subjected to disciplinary action from any employer? Describe: ______

Have you been investigated for any type of complaint? What was the outcome? Describe: ______

If you have ever been counseled or disciplined for not meeting attendance policies, please identify the employer(s) and explain what happened in each instance: ______

11 Have you ever been under the influence of alcohol or any other intoxicating substance while on the job? Explain: ______VI. EDUCATION List all high schools you have attended. Name Location Dates Attended Graduated

Higher Education: List all college or Universities attended. Name Location Dates Major Degree/GPA

VII. PRIOR APPLICATIONS Have you applied with any other law enforcement agency? Yes [ ] No [ ]. Include previous Norman Police Department applications.

Date Department Status

Have you ever had a background by this or any other agency? Yes [ ] No [ ] Year Agency Background Conducted By (Name)

VIII. INTERNET MEMBERSHIPS Please list, in the space provided below, any Internet sites or message boards to which you are a member. Internet Site Site Theme May we access this/these Site(s)?

12 IX. CRIMINAL HISTORY

NOTE: Any information of a criminal nature provided herein and/or otherwise during your background investigation with NPD may be reported to the appropriate authorities.

List the date, place and full details of each incident in the tables below (an arrest or conviction record will not necessarily disqualify you for employment).

TRAFFIC VIOLATIONS Date City, State or Country Details of Traffic Citations and Dispositions

TRAFFIC ACCIDENTS Date City, State or Country Details of Accidents (Injury/Non-injury/ at cause)

ARRESTS / OFFENSES – Juvenile and Adult List any time that you’ve been contacted by law enforcement and law enforcement has taken Date City, State or Country Details of Arrests / Offenses / Disposition – was there only a report written? ?

Have you ever been cited, arrested, charged, indicted or convicted of any criminal or traffic violations other than parking citations? Yes [ ] No [ ]

Has your driver’s license ever been suspended or revoked? Yes [ ] No [ ]

13 In your lifetime, either as an adult or juvenile, have you ever committed a crime for which you were not caught? Yes [ ] No [ ] If yes, please describe below: ______

List all incidents in which you were a , complainant, or a witness in any criminal, civil, juvenile court proceeding, an administrative or investigative hearing by any City, County, State, Federal Agency or a . ______

IX. CRIMINAL HISTORY QUESTIONNAIRE The Norman Police Department is concerned with your participation in or commission of any crime listed below. We realize that it would be a rarity for any applicant to answer “no” to all of these questions, so we place a high degree of value on a person’s honesty and integrity in answering the following questions truthfully. If you have committed or participated in any of the acts listed below, you must check the box indicating participation in the act (Yes). Following this section, you will be given ample opportunity to explain your participation in these acts.

Again, be sure to acknowledge participation, commission, arrest, conviction or questioning for any of the following acts which occurred:

______

1. Any act of unlawfully taking the life of another human being. Yes ( ) No ( )

2. Any act of unlawfully abducting another person. Yes ( ) No ( )

3. Any sexual act after you were age seventeen (17) with another person who was less than fifteen (15) years of age at the time of the act (Examples: sexual intercourse, oral sex, anal sex, or touching the genitals, breasts or anus of another person.) Yes ( ) No ( )

4. Any act, as an adult, of exposing your anus or genitals in public to arouse sexually or gratify yourself or another person. Yes ( ) No ( )

5. Any act, as an adult, of assault by striking another person with the intent to hurt the other person. Yes ( ) No ( )

6. Any act, as an adult, of cruelty to any creature or animal which results in harm, injury, or death other than legally licensed sport hunting or fishing. Yes ( ) No ( )

7. Any act of rape or sodomy, either by force or threats of injury. Yes ( ) No ( )

8. Any act involving hurting, harming, threatening, brandishing or attempting to hurt or harm another person using a firearm, knife, club, or any other deadly weapon. Yes ( ) No ( ) 14 9. Any act involving hurting, harming, abusing, striking, or injuring any person under the age of fifteen (15) years, unless it involved reasonable corporate punishment of a child who you were the legal guardian of. Yes ( ) No ( )

10. Being married to two (2) persons at the same time. Yes ( ) No ( )

11. Any incestuous act of knowingly inflicting sexual contact or sexual penetration to include sexual intercourse with your natural child, stepchild or child by adoption; natural grandchild, step-grandchild or grandchild by adoption; sister or half-sister, brother or half- brother, niece or nephew. Yes ( ) No ( )

12. Any act involving taking or keeping a child under eighteen (18) years of age out of the state in which the child resides, in violation of a judgment or order of a court disposing of the child’s custody. Yes ( ) No ( )

13. Any act of causing, planning or starting a fire or an explosion to damage or destroy a building, habitation or vehicle belonging to another person, or a building, habitation, vehicle, or property belonging to you which was insured. Yes ( ) No ( )

14. Any act, as an adult, involving the intentional damage or destruction of any property belonging to another person. Yes ( ) No ( )

15. Any act involving the use of a firearm, knife, club, deadly weapon, and physical force, threats of intimidation in order to steal or take property from another person. Yes ( ) No ( )

16. Any act involving breaking into a building, habitation or any portion of a habitation or building in order to take or steal cash, property or merchandise; or with the intent of committing any other criminal act. Yes ( ) No ( )

17. Any act, as an adult, involving breaking into a coin operated device in order to steal property, merchandise, cash or to obtain services. Yes ( ) No ( )

18. Any act involving breaking into or entering a vehicle of any kind, including cars, pickups, trucks, trailers, vans, or motor homes, in order to steal any cash, property or merchandise. Yes ( ) No ( )

19. Any act, as an adult, involving entering or remaining on the property of another, knowing that you did not have permission of the owner to do so. Yes ( ) No ( )

20. Any act, as an adult, which lawfully deprives an individual of property, cash, or merchandise through appropriation, theft, theft by false pretext, shoplifting, swindling, passing a worthless check, embezzlement, extortion, changing price tags, receiving stolen property, unlawfully receiving a service without paying for it or stealing vehicle accessories, walking a check, or any form of theft- including making a false claim to an insurance company. This does not include previously mentioned theft from employers. Yes ( ) No ( )

15 21. Any act involving any forgery of any writing, document, signature, money, any legal document, license, contract, credit card, check, security agreement, will, deed, or any deed, of trust with the intention to defraud or harm any person or business. Yes ( ) No ( )

22. Any act involving stealing a credit card, presenting a credit card to obtain property or services fraudulently, using a credit card without the consent of the person to whom the credit card was issued, using an expired card, using a fictitious card or number, using a stolen credit card, any involvement in the manufacture or counterfeit cards, buying a credit card, selling a credit card, forging a signature on a credit card receipt or in any way attempting to commit theft or to steal from anyone by using a credit card. Yes ( ) No ( )

23. Any act involving the theft of a vehicle, use of a vehicle without the owner’s consent or joy-riding in a stolen vehicle. Yes ( ) No ( )

24. Any act involving bribing or attempting to bribe any governmental officer or employee. Yes ( ) No ( )

25. Any act involving telling a lie, falsehood or misrepresentation of any act while under oath or sworn or notarized document. Yes ( ) No ( )

26. Any act, as an adult, relating to filing a false report to any police officer. Yes ( ) No ( )

27. Any act involving impersonating a peace officer, police officer, law enforcement official or other governmental official. Yes ( ) No ( )

28. Any act involving resisting or interfering with a peace officer in making any arrest or detention of any person, including you. Yes ( ) No ( )

29. Any act, as an adult, involving fleeing from, running from or evading by any means, including on foot or by vehicle, peace officer who is attempting to arrest, detain or question you or any other person. Yes ( ) No ( )

30. Any act, as an adult, involving disturbing the peace, including using abusive, profane or vulgar language to incite a breach of the peace. Yes ( ) No ( )

31. Any act, as an adult, of fighting in a public place or threatening another with physical harm in a public place. Yes ( ) No ( )

32. Any act, as an adult, of looking into a window or any opening of a building for lewd purposes. Yes ( ) No ( )

33. Any act, as an adult, involving the production, sale, distribution, promotion or possession with the intent to sell any picture, magazine, film, device, tape, book, or any other item which depicts any patently offensive sexual acts, including any form of copulation, masturbation, excretory functions, sadism, masochism or lewd exhibition. Yes ( ) No ( )

16 34. Any act, as an adult, involving engaging in any sexual act, including intercourse, oral intercourse, anal intercourse or sexual contact with the genitals, breasts or anus of another person in return for cash, property, merchandise or anything of value. Yes ( ) No ( )

35. Any act involving the receipt of compensation or anything of value for any act of prostitution committed by any person, or forcing any person by threat, intimidation or physical force to commit an act of prostitution. Yes ( ) No ( )

36. Any sexual acts involving an animal for sexual gratification. Yes ( ) No ( )

37. Any act involving the unlawful possession of any explosive device, machine gun, sawed-off shotgun or rifle, armor piercing ammunition or silencer. Yes ( ) No ( )

38. Any act, as an adult, of illegally carrying a pistol, switchblade knife, or other illegal weapons. Yes ( ) No ( )

39. Any act, as an adult, involving gambling, except for gambling in a private place in which all persons engaged in gambling have an equal chance of winning or losing and no person receives anything other than his own winnings, including promotion or a gambling house or possessing a gambling device, including dice or cards. Yes ( ) No ( )

40. Any act involving participation in any criminal enterprise or organized activity which seeks to further murder, arson, robbery, burglary, theft, kidnapping, aggravated assault, forgery, gambling, prostitution, promotion or distribution of drugs, promotion or sale of obscene materials or any other criminal act. Yes ( ) No ( )

41. Any act, as an adult or juvenile, of involvement and/or participation in any type of activity which resulted in a police investigation, arrest, and/or incarceration (other than traffic). This includes any instances where charges were filed, warrants issued and/or bond posted. Yes ( ) No ( )

42. Are you currently under investigation by any law enforcement agency concerning any alleged violation of the law? Yes ( ) No ( )

43. Are you wanted anywhere by the police at this time? Yes ( ) No ( )

44. Since the age eighteen (18) have you done anything at all for which you could have been arrested? Yes ( ) No ( )

45. Any act involving making, preparing, cutting, selling, giving, loaning, distributing, keeping for sale, or exhibiting any disc record, metal, plastic, or wax, wire or tape recording, or any type of obscene material of child pornography? Yes ( ) No ( )

BEFORE GOING ANY FURTHER, BE SURE THAT YOU HAVE CHECKED “YES” IN ALL AREAS THAT YOU RECALL HAVING PARTICIPATED IN BY COMMISION, ARREST, CONVICTION OR BEING QUESTIONED ABOUT.

17 X. PRIOR LAW ENFORCEMENT SERVICE [ ] Check this box if you have NEVER served in a position as a sworn or commissioned law enforcement officer, peace officer, sheriff’s deputy, state or federal agent, commissioned reserve officer or any other position charged and sworn to uphold the law. If you check this box, go to the next section (#11).

[ ] Check this box if you have had prior law enforcement service and please complete the following questions. These deal only with your employment as a law enforcement officer.

1. While employed as a law enforcement officer, did you ever commit a felony or misdemeanor which would have been punishable by incarceration? Yes ( ) No ( ) If yes, please explain below ______

2. Have you ever been terminated or asked to resign from a position as a law enforcement officer as a result of an internal investigation or allegation of misconduct? Yes ( ) No ( ) If yes, please explain below ______

3. While employed as a law enforcement officer, have you ever used any illegal drug or obtained illegal drugs for personal use? Yes ( ) No ( ) If yes, please explain below ______

4. While employed as a law enforcement officer, have you ever confiscated a prisoner’s or anyone else’s property and made personal use of it? Yes ( ) No ( ) If yes, please explain below ______

18 PRIOR LAW ENFORCEMENT SERVICE – Continued

5. While employed as a law enforcement officer, have you ever received any disciplinary action? Have you ever been formally investigated for misconduct or excessive use of force? Have you ever received a suspension or any written reprimands? Yes ( ) No ( ) If yes, please explain below ______

6. While employed as a law enforcement officer, have you ever filed a false police report? Yes ( ) No ( ) If yes, please explain below ______

7. While employed as a law enforcement officer, have you ever stolen anything from a crime scene? Yes ( ) No ( ) If yes please explain below ______

8. While employed as a law enforcement officer, have you ever been blackmailed by someone or have you attempted to extort someone for personal gain? Yes ( ) No ( ) If yes, please explain below ______

9. While employed as a law enforcement officer, have you ever used your position to influence others into sexual conduct or trade sexual favors to not charge someone with a crime? Yes ( ) No ( ) If yes, please explain below ______

19 XI. ILLEGAL DRUG USE Have you ever used any of the illegal drugs listed below experimentally or recreationally in your lifetime? Yes [ ] No [ ]

Please complete the following table by writing your responses in the boxes below each inquiry specific to each illegal drug (including prescription drugs used illegally) listed: 1. Indicate whether you 2. Indicate whether you 3. List the most recent have used any drug(s) have used any drug(s) date (month and year) of listed below listed below in the past your recreational or recreationally or 12 months. Mark “Y” experimental use of each experimentally. Mark for each drug used in the drug(s) listed below or “Y” for each drug used past 12 months or mark mark N/A, not applicable, or mark N/A, not N/A, not applicable, for for each drug never used. applicable, for each drug each drug not used in the not used. past 12 months.

Marijuana, Hashish, Cannabis, Medical Marijuana Cocaine, Crack Ecstasy, MDMA, Ketamine, GHB, Rohypnol Hallucinogens, LSD, Peyote, Mushrooms, Psylocybin

PCP, Angel Dust, Phencyclidine Opium, Morphine, Heroin Methamphetamine, Crank, Crystal, Ice, Speed, Amphetamine

Inhaled Aerosols (huffing), Paint, Volatile Solvents, or Nitrous Oxide

Pharmaceuticals not prescribed to you by a doctor, i.e. Oxycontin, Oxycodone, Vicodin, Methcathinone, Ritalin, Steroids (injection or pills)

20 XII. MILITARY STATUS

Have you ever served in the military services of the United States? Yes [ ] No [ ] If yes, complete the following: Branch of Service Dates Military Installation City State/Country

List all periods of active service: From: ______to: ______From: ______to: ______From: ______to: ______

While in the military, were you ever charged with an offense which resulted in a by deck court or by summary, special or general court martial; or resulted in an Article 15 or company punishment? Yes [ ] No [ ] If yes, explain: ______

List your present Selective Service Classification and number: (Unknown? Call 1-847-688-6888) ______

Were you discharged from military service under honorable conditions? Yes [ ] No [ ] If no, Explain: ______

If you are a member of a reserve unit or you are in the National Guard, please provide the following:

Branch______Active_____Inactive____Standby__

Commanding Officer______Unit______

Street Address______

Current Classification:______Current Rank:______

Grade and Service Number______

What qualifications, training, or education did you obtain in the service that would directly apply to the position of police officer? ______

21 XIII. FINANCIAL INFORMATION

Fill in the financial information section below. Be complete and accurate. The amount of indebtedness in itself will not be used in evaluating your qualifications, but rather the behavior exhibited in meeting your financial obligations.

Current Monthly Income Current Monthly Expenditures Monthly salary: $ Real Estate (mortgage): $ Spouse’s salary: Rent: Other monthly income - describe: Other monthly payments - describe:

Total Monthly Income: $ Total Monthly Expenditures: $

Current Assets Current Liabilities Savings: $ Real Estate Indebtedness: $ Checking: Long Term Loans: Real Estate: Charge Accounts: Stocks and Bonds: Vehicles: Life Insurance (cash value of policy): Other Liabilities - Describe: Vehicles:

Other Assets - Describe:

Total Assets: $ Total Liabilities: $

Please supply more information about your charge accounts, contracts or other liabilities. Name of Firm Type of Account Monthly Payment Balance

22 XIII. FINANCIAL INFORMATION - CONTINUED

Have you ever filed for or declared bankruptcy? Yes [ ] No [ ] If yes, please give details including (when, where, why).

Have any of your bills ever been turned over to a collection agency? Yes [ ] No [ ] If yes, please give details below including (when, firms involved, circumstances).

Have your ever had anything you purchased repossessed? Yes [ ] No [ ] If yes, please give details below including (when, firms involved, circumstances).

Have your wages ever been garnished for any reason? Yes [ ] No [ ] If yes, please give details below including (when, where, why).

Have you ever been delinquent on income tax or other tax payments: Yes [ ] No [ ] If yes, please give details below including (when, where, why).

XIV. MISCELLANEOUS

Have you ever stolen from an employer or been terminated due to theft? Explain.

______Have you ever been involved in a traffic accident where there was property damage and you departed the scene without reporting the incident? Explain.

______

Have you ever falsified any documents which resulted in your financial gain? Explain.

______

23 XIV. MISCELLANEOUS - CONTINUED

Have you ever assaulted anyone which resulted in that person being injured? Explain.

______Have you ever threatened anyone while possessing a weapon? Explain.

______Have you ever stolen cash or property in excess of $50 value at one time? Explain.

______Have you ever sold or distributed any illegal drugs (with or without profit)? Explain.

______Have you ever possessed any illegal drug or illegally obtained prescription medication? Explain.

______Do you speak, read, write, or understand any foreign language? If so, what language and how well? ______

Have you ever applied for a permit to carry a concealed weapon? If yes, list the permit number, date, issuing agency, and purpose: ______

List all other schools or training attended, subjects studied, or certificates earned: ______Please list any clubs, social or fraternal organizations, or associations of which you are currently, or ever have been, a member: ______Do you hold any personal beliefs that would preclude or cause you difficulty in your application or enforcement of all state, federal, and local laws regardless of race, gender, sexual preference, political beliefs, religious beliefs, or handicaps?______

24 XIV. MISCELLANEOUS - CONTINUED

Have you ever committed any act which would constitute negligence, gross, negligence, or discrimination on account of race, gender, sexual preference, political beliefs, religious beliefs, or handicaps?______

List all motor vehicles you own: _Year______Make______Model______Tag______VIN______

List the company name, address, and policy coverage of your automobile insurance: ______

Has your automobile insurance ever been canceled for any reason? Explain. ______

Are you a currently certified police officer? Yes [ ] No [ ] Have you ever had your certification suspended or revoked? Yes [ ] No [ ]

If you are currently certified, list the state in which you are certified: ______

Do you currently hold any certifications as a police officer (SFST, Intoxiltzer, DRE, ETC.)? ___ If so, what certifications do you possess?

1. Certification:______Date of Certification:______State:______2. Certification:______Date of Certification:______State:______3. Certification:______Date of Certification:______State:______4. Certification:______Date of Certification:______State:______5. Certification:______Date of Certification:______State:______

Are you currently a certified instructor in any law enforcement field (Firearms, Defensive Tactics, ETC.)?

1. Certification:______Date of Certification:______State:______2. Certification:______Date of Certification:______State:______3. Certification:______Date of Certification:______State:______4. Certification:______Date of Certification:______State:______5. Certification:______Date of Certification:______State:______

25 CONTINUATION PAGE 1

Question No. Answer

26 CONTINUATION PAGE 2

Question No. Answer

27 XV. VERIFYING DOCUMENTS

All Applicants: The following documents are required to be submitted with this completed personal history information packet: 1. Enlarged photocopy of current Driver’s License 2. Photocopy of Social Security card. 3. Official or certified copy of DD-214 (Page Member-4), if ever in military service. 4. Official or certified copy of your birth certificate. 5. Official or certified copy of your high school transcript 6. Official transcripts from all colleges attended. 7. Photocopy Naturalization papers, if foreign-born. 8. Photocopy of marriage certificate, if applicable. 9. Photocopy of divorce decree, if applicable. 10. Photocopy of official name change order, if applicable. 11. Photocopy of Passport information, if applicable.

Note: All effort should be made on your part to obtain these documents prior to the testing date. If you are unable to obtain any of the above-mentioned documents by the testing date, please write a note detailing which documents you are lacking and attach it to the front of this Personal History Statement stating that you have requested these items. Upon receipt of these documents, please forward them to the City of Norman’s Human Resources Department as soon as possible.

XVI. CERTIFICATION – APPLICANT SIGNATURE

Every person who shall obtain employment or appointment to any office or place of trust, by color or aid of any false or forged letter or certificate of recommendation, shall be guilty of a misdemeanor.

I certify that there are no misrepresentations, omissions, or falsifications in the foregoing statements and answers, and that the above entries made by me are true, complete, and correct to the best of my knowledge and belief and are made in good faith.

I understand that if any of the above information contains any misrepresentations or falsification or if any material information has been omitted, I may be discharged by the Norman Police Department, regardless of the time elapsed before discovery.

I understand that this application shall remain in the possession of the Norman Police Department.

My signature below certifies that I have read and understand this complete application, and agree to the terms and conditions outlined in this document.

______Signature of Applicant Date

28 CONSENT TO RELEASE INFORMATION AND RELEASE FROM LIABILITY

TO WHOM IT MAY CONCERN:

I am an applicant for a position with the Norman Police Department. The Department needs to thoroughly investigate my employment background and personal history to evaluate my qualifications to hold the position for which I have applied. I have authorized the Department to gather all available information regarding my employment background, personal history, and other information, which may be of a confidential or privileged nature.

I, the undersigned, authorize you to furnish the Norman Police Department any and all information that you have concerning me, including without limitation my work record, my background and reputation, my driving history, criminal history, including any arrest records and any information contained in any investigatory files, my medical records, my psychological testing and analysis, including recommendation(s), my military service records, my education background and records, my financial status, and other such information and records as you may have in your possession relating to me. Information of a confidential or privileged nature may be included in the materials you provide to Norman Police Department. I request your cooperation in supplying this information to the Norman Police Department.

I hereby agree to release you and those who supplied you with the above information, your company or organization, and the City of Norman, its employees and the Norman Police Department from any liability for any damage, which may result from furnishing the requested information.

I understand my rights under Title 5, United States Code, Section 552a, the Privacy Act of 1974, with regard to disclosure of records, and I waive those rights with the understanding that information furnished will be used by the Norman Police Department in conjunction with employment procedures. I will make no attempt to gain access to the information provided by you to the Norman Police Department.

______Applicant’s First, Middle and Last name (please print) Date of Birth

______Applicant’s Signature Date

______Applicant’s Current Address Phone Number

______Social Security Number Check Picture ID  ______Driver’s License number or State I.D. number Issuing State ______

Subscribed and sworn to before me on the ______day of ____, ______.

______

Notary Public in and for the State of: ______

Residing in the city of: ______.

My commission expires: ______.

NOTE: A photocopy reproduction of this request shall be for all intents and purposes as valid as the original.

29 USE OF CREDIT REPORTS FOR EMPLOYMENT PURPOSES

Authorization to be signed as a requirement of the Norman Police Department Pre-employment process.

By completing and signing this document, I agree that the Norman Police Department may obtain a consumer credit report or other information regarding me and may consult its own files for my credit report. I understand that this information will be used only for employment purposes.

Please fill out this document completely.

NOTE: The information contained in your consumer credit report is deemed substantially job related and will therefore be used as part of your pre-employment background investigation with NPD. The reason for relying on this information is to assist NPD with the judgment and decision-making elements of your background investigation.

Failure to complete this document will remove you from further consideration for employment with NPD.

Print Applicant’s First, Middle and Last Name

Social Security Number

Current Street Address

City, State, Zip Code

Home Telephone Number with Area Code

______Date Signature of Applicant

______NOTARY Subscribed and sworn to before me this ______Day of ______, 20____ My commission expires ______, 20____

30 PHYSICAL FITNESS TEST RELEASE AND WAIVER

I, , having made an application for the position of police officer for the City of Norman, hereby expressly admit and state as follows:

(1) I have been fully advised of the essential job functions of a police officer for the City of Norman; and

(2) I affirmatively state I can perform the essential job functions set forth in the job description with or without accommodation; and

(3) I understand that an overall degree of physical ability and fitness is required to be a police officer; and

(4) I have been advised of the nature of the exercises, I knowingly and voluntarily state I can safely perform the exercises, and agree to participate in the physical ability evaluation set forth herein; and

(5) I, , do hereby, and in consideration of the City of Norman, having permitted me to participate in such exercises for the purpose of evaluating my ability to perform the job functions of a police officer, waive and release the Norman Police Department of the City of Norman, Oklahoma, and any and all agents, servants, and/or employees thereof from any and all claims whatsoever which may be sustained as a result of participating in such exercises. I make this release for myself, my heirs, executors, and administrators and do hereby release the City of Norman, and all its employees or agents from any or all liability for damages incurring as a result of these tests.

(Applicant must write in your own hand, "I certify that I have read the foregoing Waiver and Release and understand its provisions.")

Date Signature of Applicant

NOTARY Subscribed and sworn to before me this Day of , 20 My commission expires , 20

31