Providing false or misleading information or purposely withholding information will result in rejection of your application, dismissal from employment and potential removal from the Civil Service eligibility list. Accordingly, all questions must be answered. If space provided is not sufficient for complete answers or you wish to furnish additional information, use the form provided to you by the Recruit Investigation Unit. Be sure to specify which section and question you are providing information for. Return this form along with other required documentation to your background investigator. This additional information must also be true and accurate.
City, State, Country
If Yes, Explain
If Yes, Briefly Explain
Explain when and under what circumstances this name was used
If Yes, Indicate the date of the change, court record location, and reason for change
List All. Starting with your primary e-mail address that you wish communications related to your application to be sent. Separate with a comma.
Mark each one of the above that describes your current relationship status
Names & Ages
Please complete the following about your current spouse/significant other. If married, include a maiden name if applicable.
Please complete the following about your former spouse/significant other. If married, include a maiden name if applicable.
List the information related to all current or former domestic partners, persons with whom you have had a child, regardless of whether you have ever been married or lived together, person you are or were in a dating or engagement relationship within the past 10 years not listed in the above section.
List the names, dates of birth, and addresses of each child
Have you ever had a temporary or permanent court order issued against you under the provisions of the following statutes?
List chronologically all of your residences since your 16th birthday starting with your current address and working backward. If you attended school away from your permanent residence then list the address you lived at while attending school. During military service be sure to list each place of residence including your base/ship/home port. Be sure to indicate physical residence. Do not use a post office box as an address.
List all persons with whom you have resided since your 16th birthday and their relationship to you. Exclude children.
List all employment since age 17. Begin with the most recent going backward. Include summer, part-time, and work study employment. You may include any verified work performed on a voluntary basis. If you were serving in the military indicate where you were located and the dates associated. If unemployed for a period of time, indicate dates of unemployment.
Has any of the following happened to you regarding your employment history? If you answered "YES" to any of the below questions, list each occurrence beginning with the most recent and working backward. Please provide the date fired, quit, or left under any conditions other than favorable.
Explain the circumstances to which you answered "YES" in the order below
Have you ever:
For each "YES" answer in the above section, explain the incident on the provided form. Return the form to your background investigator.
During the past three (3) years, provide the total number of sick or unexcused days you have missed from work. Use the date your application is signed as the beginning of the three (3) year period. For example: if your application is signed 11/29/2021, the first year for use of sick time purposes would be 11/29/2020 through 11/29/2021, the second year would be 11/29/2019 through 11/29/2020, and the final year would be 11/29/2018 through 11/29/2019. Explain the circumstances on the provided form. Return the form to your background investigator.
Please provide doctor's notes or other documentation for all excused absences. Provide these to your background investigator.
List all prior Law Enforcement experience. Begin with the most recent going backward. Include summer, part-time, and work-study employment. You may include any verified work performed for a law enforcement agency on a voluntary basis.
If "YES", provide copies of all documentation and certificates to your background investigator.
If "YES", provide copies of all documentation & certificates to your background investigator.
This includes if you were considered for employment with the Malden Police Department in the past.
Schools AttendedFill in information about all schools you have attended beyond 8th grade beginning with the most recent and working backwards. For schools you have attended within the past three (3) years, list a person who knows (or knew) you at the school such as a teacher, professor, or fellow student. For correspondence schools and extension classes, list records, locations, and addresses.
If "Yes" explain the circumstances on the provided form. Return the form to your background investigator.
*If unknown, call 1-847-688-3177 or visit https://www.sss.gov/regver/wfverification.aspx
If "Yes", explain the circumstances on the provided form. Return the form to your background investigator.
List the names of three (3) persons (fellow servicemen/women, commanding officers, etc) who knew you in the service to offer information about your background.
*You must provide your Certificate of Release or Discharge from Active Duty DD-214 for each period of non-continuous service. The Malden Police Department requires the long, un-edited form. Provide it to your background investigator.
Provide all reports and documentation related to the event(s) to your background investigator.
If necessary, provide additional info on the form provided. Return it to your background investigator.
For automobile crashes, number and explain each incident separately.
List any language other than English of which you have basic knowledge. Choose from the following terms to describe your level of proficiency.
Please ensure that you get an updated/recent CREDIT BUREAU check done at one of the following websites:
Submit the CREDIT BUREAU CHECK to your background investigator.
If you answered "YES", use the form provided and supply the date, the type of action (lien, bankruptcy judgment, etc), the name of the business (if applicable), the court involved and the docket number. Return this form to your background investigator.
List all real estate (land, houses, buildings, condominiums, etc) where you have an ownership interest as a principal, or as either the trustee or beneficiary of a real estate trust. If necessary, use the provided form for additional information. Return this form to your background investigator.
Court JurisdictionName of CaseInsurance ClaimDocket NumberOutcome
The management of personal finances is relevant to an individual's qualifications for the position of Police Officer. The amount of indebtedness in itself will not be used in evaluating your qualifications, but rather the behavior exhibited in meeting your financial obligations. Give the name and address of the individuals, companies, or others, to whom you are indebted and the extent of the debt. Include housing, vehicles, student loans, credit cards, etc. Additionally, include any loans on which you are co-signer. List any and all garnishments and indicate their status. Be complete and accurate in completing the following information.
Credit Card, Mortgage, etc
Provide copies of all bankruptcy orders to your background investigator.
If "Yes" answer all the following questions below
Check all that apply
*This information will not be used in any criminal action against you
What form of drug did you take? (crack, powder, pill)
How was it administered? (smoked, sniffed, injected, etc)
When was the last date you used the drug?
How many times in total did you use the drug(s)?
What is your drug intake at this time?
If necessary, use the provided form for additional information.
Include City, State, and Zip Code
I understand that any appointment tendered to me will be contingent upon the results of a complete character and fitness investigation, and I am aware that willfully withholding information or making false statements on this application will be the basis for rejection of my application or dismissal from the Malden Police Department and removal from the list of eligibility (Civil Service list). I agree to these conditions and hereby certify that all statements made by me on this application are true and complete, to the best of my knowledge.
I further understand that all appointments are probationary for a period of one (1) year commencing upon academy graduation. During this probationary time period my employment may be terminated at any time. I understand that I must successfully pass the Basic Student Officer Course at the police academy as well as a physical pre-screening administered by academy personnel. I also understand that the Malden Police Department has established regular night and midnight shifts. I understand that I may be called upon to work a variety of shifts including nights, holidays, and weekends. I agree to be available for any and all such assignments as the Malden Police Department may require.
NOTE: A foreign national is defined as any person who is not a citizen or national of the U.S.
Respond for the time frame of the last 7 years. Foreign financial interests (include stocks, personal property, company shares, investments, or ownership of corporate entities. Exclude U.S.-based fund managers and accounts managed through your employer).
Respond for the time frame of the last 7 years unless otherwise noted. Indicate if activity was on official US Government business.
Respond for foreign countries you have visited in the last 7 years, beginning with the most current and working back. If you have lived near a border and have made short (one day or less) trips to the neighboring country (e.g. Canada or Mexico) you do not need to list each trip. Instead, provide the time period, the code, the country, and a note ("many short trips"). DO NOT list travel under official US Government business, but you must include any personal trips made in conjunction with the official US Government travel.
The following questions pertain to your associations. For the purpose of this question, terrorism is defined as any criminal acts that involve violence or are dangerous to human life and appear to be intended to intimidate or coerce civilian population to influence policy of a government by intimidation or coercion or to affect the conduct of the government by mass destruction, assassination, or kidnapping.
This field is not part of the form submission.
* indicates a required field