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Apd-25 - Authorization For Release Of Information Form

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APD-25

AUTHORIZATION FOR RELEASE

OF INFORMATION

PD 407-159 (Rev. 02-09)

NY0303000

Applicant Processing Division

4201 Fourth Avenue

Brooklyn, New York 11232

Tel: (718) 972-2013

Fax:(718) 972-7687

_____________________________

Date

Exam No. _________________________ List No. ________________

I, _________________________________________________________, do hereby authorize the Veterans

Administration; United States Army; Navy; Air Force; Marines; Coast Guard; Military Reserves; all Law Enforcement

Agencies; City, State, and Federal Tax Bureaus; Welfare and Unemployment Services; Credit Bureaus; Schools;

Universities; Physicians; Hospitals and Institutions; all State, City and County Civil Service Commissions; and all

Federal, State, City and Local Courts, including those records relating to a Youthful Offender Adjudication, including

those pursuant to NYS CPL § 720.35; to furnish the New York City Police Department with any and all available

information and copies of records as well as current and past civil service standings and the outcome of any investiga-

tions ongoing or discontinued regarding me. This information will be used to determine my suitability for possible

appointment as a Police officer or Civilian Employee with New York City Police Department.

I authorize the New York City Police Department to make inquiry of my present and past employers regarding

my character, integrity and reputation. (Make note if you do not wish to have your present employer contacted and

provide an explanation below.)

I acknowledge by this authorization that I release you from any obligation or liability in the disclosure

of the contents of such files and the professional observations or opinions contained therein.

Yes, you may contact my present employer.

No, I do not want my present employer contacted.

Explain: __________________________________________________________________________________

_________________________________________________________________________________________

Note: A photocopy of this authorization shall be considered as effective and valid as the original.

__________________________________________

Signature of Applicant

Print Name

Sworn to me this ___________________

day of _____________________, 20____

_________________________________

Notary Public

Apd-25 - Authorization For Release Of Information Form

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