Police Department Personal History Statement Form Page 11
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2221.
Have you ever been involuntarily terminated from a job (including layoffs, firings, forced or requested resignations or
probationary release?)
Yes
No
If yes, give details. (DO NOT list any separation which resulted from a medical inability). ___________________________
___________________________________________________________________________________________________
___________________________________________________________________________________________________
22.
Has anyone, including any employer, ever investigated you or your work performance? This includes complaints from a co-
worker, supervisor, subordinate, member of the public or because of an audit? If yes, give the complete details of each incident
below. Use pages
19-20
if necessary.
Yes
No
If yes, give the complete details of each incident below:
Date: _____________________ Nature of complaint/investigation: _____________________________________________
Date: _____________________ Nature of complaint/investigation: _____________________________________________
Date: _____________________ Nature of complaint/investigation: _____________________________________________
Date: _____________________ Nature of complaint/investigation: _____________________________________________
Were the complaints/investigations against you sustained?
Yes
No
If yes, what was the result of the investigation and what discipline resulted? ______________________________________
___________________________________________________________________________________________________
___________________________________________________________________________________________________
Have you ever been the subject of any disciplinary action by an employer, including formal reprimands, warnings or
suspensions?
Yes
No If yes, give details: __________________________________________________________
___________________________________________________________________________________________________
23.
Have you ever applied for another position in law enforcement and/or tested with Public Safety Testing?
Yes
No
If yes, give the agency name, approximate date you applied and the status of your application.
___________________________________________________________________________________________________
___________________________________________________________________________________________________
24.
List other persons employed in law enforcement who may be familiar enough with you to offer an opinion as to your suitability.
Also list Boise Police Department officers you know.
Name
Agency
Telephone Number
___________________________________________________________________________________________________
___________________________________________________________________________________________________
___________________________________________________________________________________________________
MILITARY:
25a. If you are an adult and were a U.S. citizen or resident alien on your 18th birthday, you must have registered with the Selective
Service within 90 days of your 18th birthday. Have you registered, and can your registration be verified?
Yes
No Selective Service registration number _______________________________________________________
If you don’t know your Selective Service Registration number, and/or want to verify it, call 847-688-6888.
25b. Have you ever served in the military? ______________ Service branch __________________________________________
25c. Date entered military service: _____________________ Type of discharge: ______________________________________
25d. Date discharged: _______________ Year in which your DD214 was issued: ______________________________________
25e. Your rank when discharged: ____________ Were you ever reduced in rank? ______________________________________
25f.
Highest rank held: ____________________________________________________________________________________
25g. Were you ever the subject of any judicial or non-judicial punishment(s) while in the Armed Forces?
Yes
No
If yes, please explain __________________________________________________________________________________
___________________________________________________________________________________________________
25h. Include any Article 15’s you may have received and the outcome. Explain the details of each episode below (include the nature
of the offense and the punishment prescribed): ______________________________________________________________
25i.
To what unit were you last assigned? _____________________________________________________________________
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