Homepage Fill Out Your Apd 5A Form
Article Structure

The APD 5A form is a critical document utilized by the New York City Police Department during the application process for civilian positions. This comprehensive questionnaire collects essential personal history information from candidates, ensuring a thorough vetting process. Applicants must diligently fill out the form using black ink and submit two completed copies, each requiring notarization. The questionnaire covers various aspects, including the applicant's personal data, residence record, and family history. It even delves into details about legal name changes, citizenship status, and any relevant tattoos or body art. Additionally, it prompts candidates to disclose their marital status, children, and other familial connections, thereby creating a clear profile of each applicant's background. Furthermore, the consequences of falsifying information are clearly stated, emphasizing the importance of honesty in each response. To maintain momentum in the hiring process, candidates are encouraged to submit all required documents quickly, as civil service lists have a limited validity period of up to four years. This form, along with adherence to its requirements, is crucial for anyone looking to secure a position within the Police Department.

Apd 5A Example

 

POLICE DEPARTMENT

 

 

APD-5A

 

CITY OF NEW YORK

CIVILIAN TITLES

Personal History of: _____________________

 

 

 

 

 

 

 

Surname

 

First Name

 

 

M.I.

Applicant for appointment as:

 

 

 

 

 

 

 

Exam No. __________ List No. __________

Social Security No.:

 

 

 

 

The answers to questions in this questionnaire must be printed in BLACK INK BY THE APPLICANT. TWO (2) copies of this questionnaire are furnished, BOTH are to be completed, notarized in the space provided on page 18, and returned to your assigned investigator as directed. If the space is insufficient to complete your answer to any question, use pages eighteen through twenty-two (18-22) which have been provided for that purpose. Indicate the question number and continue your answer. If a question is not applicable, indicate such by entering “N/A” or “NONE”. Do not leave any question blank. Mistakes made should ONLY be corrected by drawing a single line through the mistake, placing your initials at the end. MISTAKES ARE NEVER TO BE CORRECTED WITH OPAQUE CORRECTION FLUID.

Applicants are cautioned to answer every question, truthfully, completely and without evasion. Both the N.Y. State Civil Service Law and the Personnel Rules of the City of New York, (which have the force and effect of the law) provide penalties for making a false statement of material fact in any application, or for practicing any fraud or deception in obtaining or attempting to obtain municipal employment. Such penalties include rejection for appointment, revocation of appointment, and prosecution.

Civil Service lists are valid for a period of up to four (4) years from the date of promulgation. Once the Civil Service list expires, appointment from that list is no longer possible. For this reason, all candidates are urged to submit all documents as expeditiously as possible. All candidates are cautioned that failing to appear for scheduled appointments could jeopardize chances for appointment.

THE NEW YORK CITY POLICE DEPARTMENT

IS AN EQUAL OPPORTUNITY EMPLOYER

Page 1

 

Control No

Exam No.

 

.

 

 

________________________________

_________ List No.Soc

 

 

. Sec. No.

APD-5A

Surname

__________________________________

 

First Name

____________________

 

Mid. Init

______

 

.

 

PD 407-151A(Rev. 09-10)

I. PERSONAL DATA

1.

Last Name

First Name

Mid. Init.

Social Security No.

a. Have you ever had a legal name change? If so,

 

 

From: ________________________

To: ____________________ Reason: ____________________________

Court: _________________________________________________ Index No.: ___________________________

If by marriage, date of marriage: _____________________________

b. List below, any other name, alias, nickname, by which you have been known, including maiden name if you are a married female, with the reason for such use:

c. Do you have any tattoos, brands, body piercings, or other body art? Yes No

If yes, include the location and complete description, including symbolized meaning and reason for getting same.

2.

Sex: Male Female

3. Date of Birth: Month: __________ Day: _________ Year: ________

4.Birth Certificate:

 

 

 

Certificate Number

City or Town

 

 

County

 

State

5.

 

Citizenship:

Citizen of the U.S.A.?

Yes

No

 

 

 

 

 

 

 

a. What country were you born in? __________________________________

 

 

 

 

b. If not born in U.S.A., date entered U.S.A. _______________________________

 

 

 

 

c. If you are a naturalized citizen of the U.S.A., list below,

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Naturalization Certificate No.

Date

Court

 

 

City

 

State

 

d. Do you have dual citizenship with another country? Yes No

 

 

 

 

If yes, what country? ______________________________ When was it obtained? _________________________

 

 

How was it obtained? ___________________________________________________________________________

6.

 

Do you have a U.S. Resident Alien Card?

Yes

No

Expiration: __________________

 

 

If yes, how was it obtained? (Lottery, etc.) ___________________________________________________________

 

 

Alien Registration No. __________________________________________________

 

 

7.

 

Do you have a U.S. passport? Yes

No

 

 

 

 

 

 

 

 

If yes, passport no. ________________________ Date Issued ____________ Expiration Date ________________

 

 

a. Have you ever reported a passport lost or stolen?

Yes

No If yes, describe the circumstances of

 

 

the loss to include the date, location and police report number: __________________________________________

 

______________________________________________________________________________________________

 

 

b. Do you now have or have you ever had a foreign passport?

Yes No If yes, date issued ___________

 

 

Date of Surrender/Expiration ________________

Issuing Country____________________________________

 

 

c. Have you ever applied for a travel visa to travel to or from any country? If so, Date _______________________

 

 

Country ________________

Reason_______________________________________________________________

 

 

Has a visa ever been denied? ______________________________________________________________________

8.What countries outside of the U.S.A. have you traveled to? Include dates and how long you were in the country:

Country & Town, or City

Dates

Length of Stay

Purpose of Visit

 

 

 

 

 

 

 

 

 

 

 

 

Initial this page to indicate that you have provided complete and accurate information: __________

Page 2

9.Marital Status:

 

 

Single Married Legally Separated Divorced Widowed Registered Domestic Partner/Civil Union

 

 

 

 

 

 

 

 

 

Spouse/Registered Domestic Partner

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Name

 

Home Address (number/street/apt.)

City

State

ZIP

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

D.O.B.

 

Occupation

 

 

 

 

N/A

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Home Phone

 

Work Address (number/street/apt.)

City

State

ZIP

 

 

(

)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Work Phone

 

Cell Phone

Email

 

 

 

 

 

(

)

 

(

)

 

 

 

 

 

 

 

 

 

 

 

 

 

Is There, Or Has There Ever Been, An Order Of Protection Or Restraining Order Issued Against This Individual?

 

 

 

 

Yes

No

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Former Spouse/Registered Domestic Partner

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Name

 

Home Address (number/street/apt.)

City

State

ZIP

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

D.O.B.

 

Occupation

 

 

 

 

N/A

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Home Phone

 

Work Address (number/street/apt.)

City

State

ZIP

 

 

(

)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Work Phone

 

Cell Phone

Email

 

 

 

 

 

(

)

 

(

)

 

 

 

 

 

 

 

 

 

 

 

 

 

Is There, Or Has There Ever Been, An Order Of Protection Or Restraining Order Issued Against This Individual?

 

 

 

 

Yes

No

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Former Spouse/Registered Domestic Partner

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Name

 

Home Address (number/street/apt.)

City

State

ZIP

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

D.O.B.

 

Occupation

 

 

 

 

N/A

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Home Phone

 

Work Address (number/street/apt.)

City

State

ZIP

 

 

(

)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Work Phone

 

Cell Phone

Email

 

 

 

 

 

(

)

 

(

)

 

 

 

 

 

 

 

 

 

 

 

 

 

Is There, Or Has There Ever Been, An Order Of Protection Or Restraining Order Issued Against This Individual?

 

 

 

 

Yes

No

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Former Spouse/Registered Domestic Partner

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Name

 

Home Address (number/street/apt.)

City

State

ZIP

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

D.O.B.

 

Occupation

 

 

 

 

N/A

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Home Phone

 

Work Address (number/street/apt.)

City

State

ZIP

 

 

(

)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Work Phone

 

Cell Phone

Email

 

 

 

 

 

(

)

 

(

)

 

 

 

 

 

 

 

 

 

 

 

 

 

Is There, Or Has There Ever Been, An Order Of Protection Or Restraining Order Issued Against This Individual?

 

 

 

 

Yes

No

 

 

 

 

 

Initial this page to indicate that you have provided complete and accurate information: __________

Page 3

II.RESIDENCE RECORD

10.Starting with your present address and working back, list each address (including temporary addresses) at which you have resided. Please include military and college (campus and/or off-campus) addresses. All foreign addresses must be included:

FROM

TO

Mo. Yr.

Mo.

Yr.

 

 

 

Street

Address

Apt.

No.

City or

Town

County of

Zip

State Code

PRESENT

a. Do you now or have you ever owned/co-owned any home/co-op/condo or other property? Yes No . If yes, list

AddressCity/ TownStateZipCounty

b. With whom do you co-own? ____________________________________________________________________

c. All Residence telephone number(s): (Area Code) _____-_____-________

d. All Cell phone number(s): (Area Code) _____-_____-________

e. Email address(es): _____________________________________, _____________________________________

f. Do you now have or have you ever had an account on a social networking site, such as MySpace, Facebook or Twitter? Yes No

If yes, indicate address(es) ______________________, ______________________, ______________________

III.FAMILY RECORD

11.List below all of your living or deceased children, including natural, adopted, and/or foster care. Include any other children who have ever resided with you. Provide the name and contact information of the other parent or guardian.

Child’s Name (Last, First)

 

Sex

D.O.B.

Does Child Reside with You? Yes No

If No, Enter Full Address

 

 

 

 

 

 

 

 

 

Who has Custody of Child? Include Name and Relationship

Name of other Parent

 

 

 

 

 

 

 

 

 

 

Parent’s D.O.B.

 

Parent’s Home Address

Parent’s Contact Phone No.

 

 

 

 

 

 

 

 

 

Parent’s Occupation

Parent’s Work Address

 

 

Candidate’s Current Relationship with other Parent

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Child’s Name (Last, First)

 

Sex

D.O.B.

Does Child Reside with You? Yes No

If No, Enter Full Address

 

 

 

 

 

 

 

 

 

Who has Custody of Child? Include Name and Relationship

Name of other Parent

 

 

 

 

 

 

 

 

 

 

Parent’s D.O.B.

 

Parent’s Home Address

Parent’s Contact Phone No.

 

 

 

 

 

 

 

 

 

Parent’s Occupation

Parent’s Work Address

 

 

Candidate’s Current Relationship with other Parent

 

 

 

 

 

 

 

 

 

Initial this page to indicate that you have provided complete and accurate information: __________

Page 4

 

Child’s Name (Last, First)

 

Sex

D.O.B.

Does Child Reside with You? Yes No

If No, Enter Full Address

 

 

 

 

 

 

 

Who has Custody of Child? Include Name and Relationship

Name of other Parent

 

 

 

 

 

 

 

 

 

Parent’s D.O.B.

 

Parent’s Home Address

 

Parent’s Contact Phone No.

 

 

 

 

 

 

 

 

 

Parent’s Occupation

Parent’s Work Address

 

 

Candidate’s Current Relationship with other Parent

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Child’s Name (Last, First)

 

Sex

D.O.B.

Does Child Reside with You? Yes No

If No, Enter Full Address

 

 

 

 

 

 

 

Who has Custody of Child? Include Name and Relationship

Name of other Parent

 

 

 

 

 

 

 

 

 

Parent’s D.O.B.

 

Parent’s Home Address

 

Parent’s Contact Phone No.

 

 

 

 

 

 

 

 

 

Parent’s Occupation

Parent’s Work Address

 

 

Candidate’s Current Relationship with other Parent

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Child’s Name (Last, First)

 

Sex

D.O.B.

Does Child Reside with You? Yes No

If No, Enter Full Address

 

 

 

 

 

 

 

 

 

 

 

Who has Custody of Child? Include Name and Relationship

Name of other Parent

 

 

 

 

 

 

 

 

 

 

 

 

 

Parent’s D.O.B.

 

Parent’s Home Address

 

Parent’s Contact Phone No.

 

 

 

 

 

 

 

 

 

 

 

Parent’s Occupation

Parent’s Work Address

 

 

Candidate’s Current Relationship with other Parent

 

 

 

 

 

 

 

 

 

 

a. Additional children listed on pages 18-22?

Yes No

 

 

b. What provisions have you made for the support of the children listed above?

________________________________

_______________________________________________________________________________________________

_______________________________________________________________________________________________

c. Do any of your children receive child support or other supportive income? (Social Security, disability) Yes No If yes, explain: __________________________________________________________________________________

_______________________________________________________________________________________________

_______________________________________________________________________________________________

IV. FAMILY RECORD AND REFERENCES

12.List the full names of biological mother and father; stepmothers/stepfathers; grandfathers; grandmothers; father-in-law; mother-in-law, living or deceased. The complete address for each must be listed (include city and state).

 

Father’s Name

Home Address (number/street/apt.)

 

 

City

State ZIP

 

 

 

 

 

 

 

 

 

Work Address (number/street/apt.)

 

City

State

ZIP

Occupation

 

 

 

 

 

 

 

 

 

 

 

Home Phone

 

Work Phone

 

 

Cell Phone

 

 

 

 

 

 

 

 

 

 

 

D.O.B.

 

 

Email

 

 

 

 

 

 

 

 

 

 

 

 

Place of Birth (Village or Town, City, State, Country)

 

 

 

 

 

 

 

 

 

 

Initial this page to indicate that you have provided complete and accurate information: __________

 

Page 5

Mother’s Name

Home Address (number/street/apt.)

 

 

City

State ZIP

 

 

 

 

 

 

 

Work Address (number/street/apt.)

 

City

State

ZIP

Occupation

 

 

 

 

 

 

 

 

 

Home Phone

 

Work Phone

 

 

Cell Phone

 

 

 

 

 

 

 

 

 

D.O.B.

 

 

Email

 

 

 

 

 

 

 

 

 

 

 

 

Place of Birth (Village or Town, City, State, Country)

N/A

Stepfather’s Name

Home Address (number/street/apt.)

 

 

City

State ZIP

 

 

 

 

 

 

 

Work Address (number/street/apt.)

 

City

State

ZIP

Occupation

 

 

 

 

 

 

 

 

 

Home Phone

 

Work Phone

 

 

Cell Phone

 

 

 

 

 

 

 

 

 

D.O.B.

 

 

Email

 

 

 

 

 

 

 

 

 

 

 

 

Place of Birth (Village or Town, City, State, Country)

N/A

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Stepmother’s

Name

Home Address (number/street/apt.)

 

 

City

State ZIP

 

 

 

 

 

 

 

Work Address (number/street/apt.)

 

City

State

ZIP

Occupation

 

 

 

 

 

 

 

 

 

Home Phone

 

Work Phone

 

 

Cell Phone

 

 

 

 

 

 

 

 

 

D.O.B.

 

 

Email

 

 

 

 

 

 

 

 

 

 

 

 

 

Place of Birth (Village or Town, City, State, Country)

N/A

 

Father-in-law’s Name

Home Address (number/street/apt.)

 

 

City

State

ZIP

 

 

 

 

 

 

 

 

 

 

 

Work Address (number/street/apt.)

 

City

State

ZIP

Occupation

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Home Phone

 

Work Phone

 

 

Cell Phone

 

 

 

 

 

 

 

 

 

 

 

 

 

 

D.O.B.

 

 

Email

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Place of Birth (Village or Town, City, State, Country)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

N/A

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Mother-in-law’s Name

Home Address (number/street/apt.)

 

 

City

State

ZIP

 

 

 

 

 

 

 

 

 

 

Work Address (number/street/apt.)

 

City

State

ZIP

Occupation

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Home Phone

 

Work Phone

 

 

Cell Phone

 

 

 

 

 

 

 

 

 

 

 

 

 

 

D.O.B.

 

 

Email

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Place of Birth (Village or Town, City, State, Country)

 

 

 

 

 

 

 

 

 

 

 

Initial this page to indicate that you have provided complete and accurate information: __________

 

 

Page 6

N/A

Grandmother’s Name

Home Address (number/street/apt.)

 

 

City

State ZIP

 

 

 

 

 

 

 

Work Address (number/street/apt.)

 

City

State

ZIP

Occupation

 

 

 

 

 

 

 

 

 

Home Phone

 

Work Phone

 

 

Cell Phone

 

 

 

 

 

 

 

 

 

D.O.B.

 

 

Email

 

 

 

 

 

 

 

 

 

 

 

 

Place of Birth (Village or Town, City, State, Country)

N/A

Grandfather’s Name

Home Address (number/street/apt.)

 

 

City

State ZIP

 

 

 

 

 

 

 

Work Address (number/street/apt.)

 

City

State

ZIP

Occupation

 

 

 

 

 

 

 

 

 

Home Phone

 

Work Phone

 

 

Cell Phone

 

 

 

 

 

 

 

 

 

D.O.B.

 

 

Email

 

 

 

 

 

 

 

 

 

 

 

 

Place of Birth (Village or Town, City, State, Country)

a.List the full names of all biological brothers and sisters; half-brothers/half-sisters; stepbrothers/stepsisters; uncle; aunt; great aunt; great uncle; first cousin; nephew; niece; fiancé or fiancée, living or deceased (include females’ maiden names). The complete address for each must be listed (must include city and state).

N/A

Name

 

Relationship

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Home Address (number/street/apt.)

City

State

ZIP

D.O.B.

 

 

 

 

 

Work Address (number/street/apt.)

City

State

ZIP

Occupation

 

 

 

 

 

 

 

Home Phone

Work Phone

 

Cell Phone

 

 

Email

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

N/A

Name

 

Relationship

 

 

 

 

 

 

 

 

 

Home Address (number/street/apt.)

City

State

ZIP

D.O.B.

 

 

 

 

 

Work Address (number/street/apt.)

City

State

ZIP

Occupation

 

 

 

 

 

 

 

Home Phone

Work Phone

 

Cell Phone

 

 

Email

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

N/A

Name

 

Relationship

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Home Address (number/street/apt.)

City

State

ZIP

D.O.B.

 

 

 

 

 

 

 

 

Work Address (number/street/apt.)

City

State

ZIP

Occupation

 

 

 

 

 

 

 

 

Home Phone

Work Phone

 

Cell Phone

 

 

Email

 

 

 

 

 

 

 

 

Initial this page to indicate that you have provided complete and accurate information: __________

Page 7

N/A

Name

 

Relationship

 

 

 

 

 

 

 

 

 

 

 

Home Address (number/street/apt.)

City

State

ZIP

D.O.B.

 

 

 

 

 

 

 

 

Work Address (number/street/apt.)

City

State

ZIP

Occupation

 

 

 

 

 

 

 

 

Home Phone

Work Phone

 

Cell Phone

 

 

Email

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

N/A

Name

 

Relationship

 

 

 

 

 

 

 

 

 

 

 

Home Address (number/street/apt.)

City

State

ZIP

D.O.B.

 

 

 

 

 

 

 

 

Work Address (number/street/apt.)

City

State

ZIP

Occupation

 

 

 

 

 

 

 

 

Home Phone

Work Phone

 

Cell Phone

 

 

Email

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

N/A

Name

 

Relationship

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Home Address (number/street/apt.)

City

State

ZIP

D.O.B.

 

 

 

 

 

 

 

 

Work Address (number/street/apt.)

City

State

ZIP

Occupation

 

 

 

 

 

 

 

 

Home Phone

Work Phone

 

Cell Phone

 

 

Email

 

 

 

 

 

 

 

 

b.List any person(s) who has ever resided with you, whether related to you or not (include females’ maiden names). The complete address for each must be listed (must include city and state).

N/A

Name

 

Relationship

 

 

 

 

 

 

 

 

 

Home Address (number/street/apt.)

City

State

ZIP

D.O.B.

 

 

 

 

 

Work Address (number/street/apt.)

City

State

ZIP

Occupation

 

 

 

 

 

 

 

Home Phone

Work Phone

 

Cell Phone

 

 

Email

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

N/A

Name

 

Relationship

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Home Address (number/street/apt.)

City

State

ZIP

D.O.B.

 

 

 

 

 

Work Address (number/street/apt.)

City

State

ZIP

Occupation

 

 

 

 

 

 

 

Home Phone

Work Phone

 

Cell Phone

 

 

Email

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

N/A

Name

 

Relationship

 

 

 

 

 

 

 

 

 

 

 

Home Address (number/street/apt.)

City

State

ZIP

D.O.B.

 

 

 

 

 

 

 

 

Work Address (number/street/apt.)

City

State

ZIP

Occupation

 

 

 

 

 

 

 

 

Home Phone

Work Phone

 

Cell Phone

 

 

Email

 

 

 

 

 

 

 

 

Initial this page to indicate that you have provided complete and accurate information: __________

Page 8

c.List 5-6 people who know you well, such as social and family friends, co-workers, military acquaintances. Do not include relatives, employers or housemates, or other individuals listed elsewhere.

Name

 

How do you know this person?

 

 

 

 

 

(for example: friend, teacher,

 

 

 

 

 

family friend, co-worker)

 

 

 

Home Address (number/street/apt.)

City

State

ZIP

D.O.B.

 

 

 

 

 

 

 

Work Address (number/street/apt.)

City

State

ZIP

Occupation

 

 

 

 

 

 

 

Home Phone

Work Phone

 

Cell Phone

 

 

Email

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Name

 

How do you know this person?

 

 

 

 

 

(for example: friend, teacher,

 

 

 

 

 

family friend, co-worker)

 

 

 

Home Address (number/street/apt.)

City

State

ZIP

D.O.B.

 

 

 

 

 

 

 

Work Address (number/street/apt.)

City

State

ZIP

Occupation

 

 

 

 

 

 

 

Home Phone

Work Phone

 

Cell Phone

 

 

Email

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Name

 

How do you know this person?

 

 

 

 

 

(for example: friend, teacher,

 

 

 

 

 

family friend, co-worker)

 

 

 

Home Address (number/street/apt.)

City

State

ZIP

D.O.B.

 

 

 

 

 

 

 

Work Address (number/street/apt.)

City

State

ZIP

Occupation

 

 

 

 

 

 

 

Home Phone

Work Phone

 

Cell Phone

 

 

Email

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Name

 

How do you know this person?

 

 

 

 

 

(for example: friend, teacher,

 

 

 

 

 

family friend, co-worker)

 

 

 

Home Address (number/street/apt.)

City

State

ZIP

D.O.B.

 

 

 

 

 

 

 

Work Address (number/street/apt.)

City

State

ZIP

Occupation

 

 

 

 

 

 

 

Home Phone

Work Phone

 

Cell Phone

 

 

Email

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Name

 

How do you know this person?

 

 

 

 

 

(for example: friend, teacher,

 

 

 

 

 

family friend, co-worker)

 

 

 

Home Address (number/street/apt.)

City

State

ZIP

D.O.B.

 

 

 

 

 

 

Work Address (number/street/apt.)

City

State

ZIP

Occupation

 

 

 

 

 

 

 

Home Phone

Work Phone

 

Cell Phone

 

 

Email

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Name

 

How do you know this person?

 

 

 

 

 

(for example: friend, teacher,

 

 

 

 

 

family friend, co-worker)

 

 

 

Home Address (number/street/apt.)

City

State

ZIP

D.O.B.

 

 

 

 

 

 

Work Address (number/street/apt.)

City

State

ZIP

Occupation

 

 

 

 

 

 

 

Home Phone

Work Phone

 

Cell Phone

 

 

Email

 

 

 

 

 

 

 

Initial this page to indicate that you have provided complete and accurate information: __________

Page 9

V.FOREIGN CONTACTS (OR LANGUAGE)

13a. Do you speak, read, write, or understand a foreign language? Yes No . If Yes, list language(s) and educational level of proficiency: ____________________________________________________________________

b.How often is each language(s) used? ________________________________________________________________

c.With whom is each language used? ____________________________ How often?__________________________

d.Is this person inside or outside of the United States? Inside Outside

If outside, list country ____________________________________________________________________________

VI. EDUCATION RECORD

14. List all schools you have attended beginning with the 9th grade:

School Name,

City, State and Zip Code

Month and Year

Attended

From To

Number of Credit Hours

Completed

Semester Quarter

Type of Degree

(e.g. H.S. Diploma,

B.A., M.A.)

Month and Year

of Graduation,

Degree

a.List any other schools attended, including but not limited to, trade, vocation, business, professional and occupational licenses, training courses, internships, certificate programs, etc. List the dates of attendance.

_______________________________________________________________________________________________

_______________________________________________________________________________________________

_______________________________________________________________________________________________

b.

High school diploma from an accredited U.S. Institution? Yes No

G.E.D.

Yes No

 

If “Yes”, G.E.D.-Issuing State _____________________ Date Issued ___________

Other ___________________

c.Were you ever the subject of any disciplinary action at any educational institution which you attended?

Yes No If “yes” give details on pages 18 through 22. (School name, disposition date, etc.)

VII. EMPLOYMENT RECORD

15.Have you ever been fired or suspended from any job, or has any form of disciplinary action been taken against you by any employer? Yes No . If Yes, explain below.

______________________________________________________________________________________________

______________________________________________________________________________________________

______________________________________________________________________________________________

List below, starting with your current employment-or unemployment - and working back, each period of employ- ment and period of unemployment you have had. Include within the sequence any period of active military ser- vice. If you were discharged from any employment, or requested to resign, so state under “Reason for leaving employment”. DO NOT LEAVE ANY TIME PERIODS UNACCOUNTED FOR.

From

 

 

 

To

 

Full Time

Name of Supervisor:

Mo.:

 

Yr.:

 

 

 

PRESENT

Part Time

 

 

 

 

 

 

Company Name (it unemployed, so state)

 

 

Type of work you performed:

Street Address of Company

Employer’s Telephone Number:

City, State and Zip Code

Reason for leaving employment:

From

 

 

 

To

 

 

Full Time

Name of Supervisor:

Mo.:

Yr.:

 

 

Mo.:

 

Yr.:

 

Part Time

 

 

 

 

 

 

 

 

Company Name (if unemployed, so state)

 

 

 

Type of work you performed:

Street Address of Company

Employer’s Telephone Number:

City, State and Zip Code

Reason for leaving employment:

Continue employment entries on Page 11

Initial this page to indicate that you have provided complete and accurate information: __________

Page 10

Form Characteristics

Fact Name Description
Form Purpose The APD 5A form collects personal history information for applicants seeking employment with the New York City Police Department.
Submission Requirements Applicants must complete two copies of the form, notarize them, and return them to their designated investigator.
Correction Protocol Errors should only be corrected by striking through the mistake and initialing. Use of correction fluid is strictly prohibited.
Truthfulness Requirement Applicants must provide truthful and complete responses. False statements can result in rejection or revocation of appointment.
Document Expiration Civil Service lists remain valid for four years. After expiration, appointment from the list is invalid.
Equal Opportunity The New York City Police Department is committed to being an equal opportunity employer.

Guidelines on Utilizing Apd 5A

Completing the APD-5A form requires careful attention to detail and accuracy. Throughout the process, every question must be answered truthfully. After all sections have been filled out, the form will need to be notarized and submitted to the assigned investigator. This step is crucial to ensure your application is processed efficiently.

  1. Obtain the Form: Ensure you have the APD-5A form and two copies.
  2. Fill Out Personal Information: Start with your surname, first name, and middle initial at the top of the form.
  3. Enter Identification Details: Provide your social security number, exam number, and list number. Use black ink.
  4. Answer Name Change Question: If applicable, indicate whether you've had a legal name change, including details such as the former name, reason, and any court information.
  5. List Any Aliases: Include nicknames or maiden names as needed with the reasons for their use.
  6. Body Art Information: Indicate whether you have tattoos, brands, or piercings, and describe them.
  7. Complete Personal Data: Provide your sex, date of birth, and birth certificate information.
  8. Citizenship Details: Confirm your U.S. citizenship status. If applicable, provide details about naturalization.
  9. Resident Alien Card: Complete the section if you have this card, including its expiration date.
  10. Passport Information: Indicate whether you have a U.S. passport and provide the necessary details.
  11. Travel History: List countries outside the U.S. that you have visited, including dates and duration of stay.
  12. Marital Status: Mark your current marital status and provide details of your spouse or registered domestic partner if applicable.
  13. Residence Record: List all past and current addresses, including temporary ones, in chronological order.
  14. Family Information: Document details of living or deceased children, including custody information and parental details.
  15. Family Record and References: Include full names and addresses of family members, such as parents and grandparents.
  16. Complete Remaining Sections: Fill out any additional information requested in later sections of the form.
  17. Notarize the Form: After fully completing both copies, have them notarized in the designated section.
  18. Submit the Form: Return the notarized forms to your assigned investigator by the instructed method.

After submission, patience is essential. The reviewing process will take time, and follow-up communication may vary depending on the investigation's progress. Ensure to keep a copy of your completed form and any notes for your records.

What You Should Know About This Form

What is the purpose of the APD 5A form?

The APD 5A form serves as a personal history questionnaire for applicants seeking employment with the New York City Police Department. It gathers essential information regarding the applicant’s identity, background, and qualifications for the role.

Who needs to fill out the APD 5A form?

Individuals applying for civilian positions within the New York City Police Department must complete the APD 5A form. This includes applicants who are participating in civil service examinations and seeking employment in various roles as indicated by the job listings.

What should I do if I make a mistake while filling out the form?

If an error is made, applicants should correct it by drawing a single line through the mistake and placing their initials at the end of the correction. It is important not to use correction fluid to modify any entries on the form.

Can I leave questions blank if I don’t have an answer?

No. All questions must be answered completely. If a question does not apply to you, enter “N/A” or “NONE.” Leaving any question blank may result in delays or disqualification from the application process.

How many copies of the APD 5A form do I need to submit?

Applicants must complete two copies of the APD 5A form. Both copies need to be notarized and submitted to the assigned investigator as directed. Failure to submit both copies may impede the application process.

What happens if I don’t submit the form on time?

The civil service lists from which the appointments are made are valid for up to four years. If you fail to submit the required documents promptly, it may jeopardize your chances for appointment. Timeliness is crucial in this process.

Is there a specific ink color that should be used to fill out the APD 5A form?

Yes, applicants must print their answers using black ink. This requirement helps ensure that the information is clear and legible for processing purposes.

What are the penalties for providing false information on the APD 5A form?

Providing false information can result in significant consequences, including rejection for appointment, revocation of an already granted position, and possible legal prosecution. Applicants should answer all questions truthfully and thoroughly.

Common mistakes

Completing the APD 5A form can seem daunting, and many applicants make common errors. One frequent mistake is not using black ink. The instructions clearly state that all answers must be printed in black ink by the applicant. Using other colors can lead to issues, and the application may be returned.

Another mistake is leaving questions blank. Each question must have a response, even if it is not applicable. If a question does not apply, candidates should write "N/A" or "NONE." This omission can result in delays or complications in the application process.

Many applicants also fail to provide accurate personal history. This includes information about previous names, legal name changes, and the correct spelling of names. It is essential to ensure that all parts of the personal history are complete and truthful. Errors in this section can undermine an applicant's integrity.

Correcting mistakes can lead to further issues. The form specifies that corrections should be made only by drawing a single line through the mistake and initialing it. Using correction fluid to hide errors is forbidden and may result in the application being discarded. Proper correction methods should always be adhered to.

Thirdly, applicants sometimes forget to notarize both copies of the questionnaire. Notarization is a critical step that verifies the identity of the applicant and the authenticity of the document. Failure to notarize can result in delays or rejection of the application.

Lastly, candidates may overlook the importance of thoroughness when providing background information, especially regarding previous addresses and family records. Missing details can lead the reviewing officer to question the completeness and accuracy of the application. Providing complete information upfront can save time and enhance the prospects of securing an appointment.

Documents used along the form

The APD 5A form is a comprehensive document utilized by the New York City Police Department during the civil service appointment process for civilian titles. As candidates navigate their application journey, they may encounter several other forms and documents that are integral to the process. Understanding these additional documents can ensure candidates are fully prepared and can streamline the application experience.

  • NYC Civil Service Application: This document serves as the official application form for candidates seeking employment within the New York City civil service system. It collects basic personal information, employment history, and qualifications relevant to the position. Candidates must submit this form along with their APD 5A to initiate their application.
  • Background Investigation Consent Release: This form grants permission for the New York City Police Department to conduct a thorough background check on the applicant. It typically includes authorizations for the investigation of criminal records, employment history, and references. By signing this document, candidates affirm that they understand and agree to the background investigation process.
  • Medical History Disclosure Form: Candidates are often required to complete this form to share details about their medical history, including any previous or current health conditions. This is crucial for determining physical fitness and suitability for the position they are applying for. Employment in law enforcement, for instance, often demands certain physical capabilities.
  • Fingerprinting Consent Form: This document allows the police department to gather the applicant’s fingerprints as part of the background investigation. Fingerprinting is a standard procedure to verify identity and check for any criminal records. Applicants must complete this form to comply with the fingerprinting requirements necessary for employment consideration.

By preparing and understanding these documents alongside the APD 5A form, applicants can enhance their readiness and potentially expedite the civil service application process. Each form plays an indispensable role in ensuring that candidates meet the necessary standards for employment within the New York City Police Department.

Similar forms

  • Application for Employment: Similar in structure, both documents require personal details, work history, and clarification of background information before assessing a candidate for employment.
  • Background Check Form: Like the APD 5A form, this document collects detailed personal and professional history to evaluate an individual's suitability for a position.
  • Personal History Statement (PHS): This statement also requires comprehensive personal information, including names, addresses, and employment history, to assist in background checks.
  • Medical History Questionnaire: Aimed at gathering health-related information, this questionnaire shares the same format of requiring complete and truthful responses from the applicant.
  • Notarized Statements: Similar to the requirement for notarization in the APD 5A form, other documents may also need official verification of identity and signature.
  • Affidavit of Identity: This legal document often requires similar personal data to confirm the identity of the individual as seen in the APD 5A form

Dos and Don'ts

When filling out the APD-5A form, follow these essential dos and don'ts to ensure a smooth application process:

  • Print your answers legibly in BLACK INK.
  • Complete BOTH copies of the questionnaire and return them as directed.
  • If you run out of space for an answer, continue on pages 18-22, clearly indicating the question number.
  • Mark “N/A” or “NONE” for questions that are not applicable.
  • Sign and date both copies of the form where required.
  • Do not leave any questions blank. Every query must have a response.
  • Avoid using correction fluid. Instead, draw a single line through mistakes and initial next to them.
  • Do not provide false information or omit details; doing so can lead to serious consequences.
  • Never submit the form without reviewing it for accuracy and completeness.

Misconceptions

Misconception 1: The APD 5A form is optional for applicants.

Many applicants mistakenly believe that completing the APD 5A form is a choice. In reality, it is a crucial requirement for anyone seeking appointment with the New York City Police Department.

Misconception 2: You can use white-out to correct mistakes on the form.

Some individuals think it's acceptable to use correction fluid to fix errors. However, the instructions clearly state that mistakes should be corrected by drawing a single line through the error and initialing it. Using correction fluid can lead to immediate disqualification.

Misconception 3: Only full-time residents of New York City can apply.

Another common belief is that only individuals residing in NYC are eligible to submit the APD 5A form. In fact, the application is open to anyone who meets the necessary qualifications and is willing to work for the Police Department, regardless of current residence.

Misconception 4: Not mentioning a past legal issue will not impact your application.

Some applicants think that omitting past legal issues will go unnoticed. However, the form requires complete honesty and transparency. Failing to disclose relevant information can result in penalties, including application rejection or criminal charges.

Misconception 5: Only one copy of the form needs to be submitted.

Applicants often believe that submitting a single copy of the form suffices. The guidelines specify that applicants must submit two completed and notarized copies. Not adhering to this requirement can delay the application process.

Key takeaways

Filling out the APD-5A form can seem daunting, but it is an essential step for those applying for a position within the New York City Police Department. Here are key takeaways to keep in mind while completing and submitting the form:

  • Use Black Ink: Answers must be printed in black ink by the applicant. This helps ensure clarity and readability.
  • Complete Two Copies: You must fill out and notarize two copies of the questionnaire. Both copies need to be returned to your assigned investigator.
  • Be Thorough: Do not leave any questions blank. If a question does not apply to you, indicate this by writing “N/A” or “NONE.”
  • Correction Protocol: If an error occurs, simply draw a line through the mistake and initial it. Avoid using correction fluid as this can lead to disqualification.
  • Truthfulness is Crucial: It's imperative to answer every question honestly and completely. False statements can lead to rejection, revocation of appointment, or even prosecution.
  • Understanding Timeframes: Civil Service lists are valid for up to four years. Submit your documents promptly to ensure you remain eligible for appointment.
  • Attend Scheduled Appointments: Failing to show up for scheduled meetings can negatively impact your chances of getting the job. Stay organized and make attendance a priority.

By following these guidelines, applicants can enhance their chances of successfully completing the APD-5A form and moving forward in the hiring process.