Police Officer Applicant Background Questionnaire - Sierra Vista Police Department Page 9
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2424.
POLICE CONTACTS: List all incidents in which you were cited, arrested, accused or charged with a crime other than traffic
violations.
Include
incidents that occurred as a juvenile, any that were expunged, set aside, dismissed, referred to pre-trial diversion or
pardoned.
Provide a full
explanation on the Continuation Sheet.
Date
Location
Police Agency
Original Charge
Disposition/Court Action
25.
CIVIL ACTIONS List all civil actions in which you were a party, (i.e., divorces, bankruptcy, small claims court, lawsuits
etc.):
Date
Location
Action or Proceeding
Disposition/Court Action
26.
CURRENT DRIVER'S LICENSE
27.
PREVIOUS DRIVER'S LICENSE INFORMATION
List all states/countries where you have been
licensed:
State:
Expiration Date:
Current Drivers License Number:
Have you ever had your Driver's License revoked or suspended? YES NO
28.
If YES, provide a full explanation on the Continuation Sheet.
29.
MOTOR VEHICLE OPERATION:
List all moving violations for which you were
cited.
Use the Continuation Sheet if
necessary:
Date
Location and Issuing Agency
Violation Charged
Collision Related
Court Disposition
YES
NO
YES
NO
YES
NO
YES
NO
YES
NO
YES
NO
AGENCY VERIFICATION:
INITIALS:
DATE:
INITIALS:
Police Contacts Queried and Results Documented in Files
Civil Actions Queried and Results Documented in Files
Motor Vehicle Records Queried and Results Documented in File
AZ POST Form PH (Sept. 2015) Page 6 of 10
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