Police Officer Applicant Background Questionnaire - Sierra Vista Police Department Page 13
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24Applicant Name:
Agency:
AGENCY VERIFICATON OF APPLICANTS
QUALIFICATIONS AND DOCUMENTATION
Please
initial
Page 1
Code of Ethics read, signed and dated.
Page 2
Authorization for Release of Information fully completed and notarized.
Page 3
Agency Verification completed and results documented in file.
Page 4
Agency Verification completed and results documented in file.
Page 5
Agency Verification completed and results documented in file.
Page 6
Agency Verification completed and results documented in file.
Page 7
Agency Verification completed and results documented in file.
Page 8
Agency Verification completed and results documented in file.
In-Person Review of AZPOST PH with Applicant to confirm information
Lateral Applicants – Prior Agency personnel file reviewed for past performance and/or prior misconduct
Applicant has applied with other agencies – inquiry completed with agency to determine status and/or disqualifiers identified.
Inconsistent information from applicant during background process, including polygraph, corrected by applicant on AZPOST PH
form.
Applicant meets minimum qualifications and documentation is complete and in file.
Application Process Terminated
Applicant does not meet minimum qualifications.
Reason for Disqualification:
Medical Examination completed and in file and applicant meets standards.
Medical Examination completed and in file and applicant does not meet standards
ME and MH forms properly completed and in file.
F.B.I./D.P.S. record checks completed and in file.
F.B.I./D.P.S. record checks completed and in file and reflects arrest record.
F.B.I./D.P.S. record checks has been submitted, no return yet.
NCIC/III/ACIC/ACCH records check completed and in file and no record found.
NCIC/III/ACIC/ACCH records check completed and in file and record found.
Polygraph completed and report in file and applicant passed
Polygraph completed and report in file and applicant failed.
Application Process Terminated
Applicant does not meet all requirements.
Reason for Disqualification:
AGENCY CERTIFICATION:
I hereby certify that I have reviewed this application for completeness and the required documentation in accordance with R13-4-
106(C)(7) and hereby attest that this person meets minimum qualifications for appointment, has not engaged in conduct or a pattern
of conduct that would jeopardize public trust in the law enforcement profession, is of good moral character and have completed this
report to document that finding.
NAME OF REVIEWER:
TITLE:
SIGNATURE OF REVIEWER:
DATE:
AZ POST Form PH (Sept. 2015) Page 10 of 10
13
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