Fill Out Your Apd 5A Form
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
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POLICE DEPARTMENT |
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CITY OF NEW YORK |
CIVILIAN TITLES |
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Personal History of: _____________________ |
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Surname |
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First Name |
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M.I. |
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Applicant for appointment as: |
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Exam No. __________ List No. __________ |
Social Security No.: |
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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
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
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Control No |
Exam No. |
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_________ List No.Soc |
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Surname |
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First Name |
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Mid. Init |
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I. PERSONAL DATA
1.
Last Name |
First Name |
Mid. Init. |
Social Security No. |
a. Have you ever had a legal name change? If so, |
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From: ________________________ |
To: ____________________ Reason: ____________________________ |
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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.
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Sex: Male Female |
3. Date of Birth: Month: __________ Day: _________ Year: ________ |
4.Birth Certificate:
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Citizen of the U.S.A.? |
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No |
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a. What country were you born in? __________________________________ |
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b. If not born in U.S.A., date entered U.S.A. _______________________________ |
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c. If you are a naturalized citizen of the U.S.A., list below, |
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Naturalization Certificate No. |
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d. Do you have dual citizenship with another country? Yes No |
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If yes, what country? ______________________________ When was it obtained? _________________________ |
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How was it obtained? ___________________________________________________________________________ |
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Do you have a U.S. Resident Alien Card? |
Yes |
No |
Expiration: __________________ |
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If yes, how was it obtained? (Lottery, etc.) ___________________________________________________________ |
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Alien Registration No. __________________________________________________ |
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Do you have a U.S. passport? Yes |
No |
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If yes, passport no. ________________________ Date Issued ____________ Expiration Date ________________ |
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a. Have you ever reported a passport lost or stolen? |
Yes |
No If yes, describe the circumstances of |
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the loss to include the date, location and police report number: __________________________________________ |
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b. Do you now have or have you ever had a foreign passport? |
Yes No If yes, date issued ___________ |
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Date of Surrender/Expiration ________________ |
Issuing Country____________________________________ |
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c. Have you ever applied for a travel visa to travel to or from any country? If so, Date _______________________ |
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Country ________________ |
Reason_______________________________________________________________ |
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Has a visa ever been denied? ______________________________________________________________________ |
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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 |
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Initial this page to indicate that you have provided complete and accurate information: __________
Page 2
9.Marital Status:
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Single Married Legally Separated Divorced Widowed Registered Domestic Partner/Civil Union |
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Spouse/Registered Domestic Partner |
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D.O.B. |
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N/A |
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Is There, Or Has There Ever Been, An Order Of Protection Or Restraining Order Issued Against This Individual? |
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Yes |
No |
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Former Spouse/Registered Domestic Partner |
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D.O.B. |
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N/A |
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Is There, Or Has There Ever Been, An Order Of Protection Or Restraining Order Issued Against This Individual? |
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Former Spouse/Registered Domestic Partner |
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D.O.B. |
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Is There, Or Has There Ever Been, An Order Of Protection Or Restraining Order Issued Against This Individual? |
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Former Spouse/Registered Domestic Partner |
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D.O.B. |
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Is There, Or Has There Ever Been, An Order Of Protection Or Restraining Order Issued Against This Individual? |
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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
FROM |
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Mo. Yr. |
Mo. |
Yr. |
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Street
Address
Apt.
No.
City or
Town
County of
Zip
State Code
PRESENT
a. Do you now or have you ever
AddressCity/ TownStateZipCounty
b. With whom do you
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) |
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Sex |
D.O.B. |
Does Child Reside with You? Yes No |
If No, Enter Full Address |
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Who has Custody of Child? Include Name and Relationship |
Name of other Parent |
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Parent’s D.O.B. |
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Parent’s Home Address |
Parent’s Contact Phone No. |
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Parent’s Occupation |
Parent’s Work Address |
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Candidate’s Current Relationship with other Parent |
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Child’s Name (Last, First) |
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Sex |
D.O.B. |
Does Child Reside with You? Yes No |
If No, Enter Full Address |
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Who has Custody of Child? Include Name and Relationship |
Name of other Parent |
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Parent’s D.O.B. |
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Parent’s Home Address |
Parent’s Contact Phone No. |
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Parent’s Occupation |
Parent’s Work Address |
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Candidate’s Current Relationship with other Parent |
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Initial this page to indicate that you have provided complete and accurate information: __________
Page 4
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Child’s Name (Last, First) |
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Sex |
D.O.B. |
Does Child Reside with You? Yes No |
If No, Enter Full Address |
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Who has Custody of Child? Include Name and Relationship |
Name of other Parent |
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Parent’s D.O.B. |
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Parent’s Home Address |
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Parent’s Occupation |
Parent’s Work Address |
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Candidate’s Current Relationship with other Parent |
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Child’s Name (Last, First) |
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Sex |
D.O.B. |
Does Child Reside with You? Yes No |
If No, Enter Full Address |
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Who has Custody of Child? Include Name and Relationship |
Name of other Parent |
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Parent’s D.O.B. |
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Parent’s Home Address |
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Parent’s Occupation |
Parent’s Work Address |
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Candidate’s Current Relationship with other Parent |
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Child’s Name (Last, First) |
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D.O.B. |
Does Child Reside with You? Yes No |
If No, Enter Full Address |
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Who has Custody of Child? Include Name and Relationship |
Name of other Parent |
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Parent’s D.O.B. |
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Parent’s Home Address |
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Parent’s Occupation |
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a. Additional children listed on pages |
Yes No |
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b. What provisions have you made for the support of the children listed above? |
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_______________________________________________________________________________________________
_______________________________________________________________________________________________
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;
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Home Address (number/street/apt.) |
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D.O.B. |
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Place of Birth (Village or Town, City, State, Country) |
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Initial this page to indicate that you have provided complete and accurate information: __________ |
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Page 5
Mother’s Name |
Home Address (number/street/apt.) |
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State ZIP |
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Work Address (number/street/apt.) |
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Home Phone |
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D.O.B. |
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Place of Birth (Village or Town, City, State, Country)
N/A
Stepfather’s Name |
Home Address (number/street/apt.) |
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Home Phone |
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D.O.B. |
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Place of Birth (Village or Town, City, State, Country)
N/A |
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Stepmother’s |
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Home Address (number/street/apt.) |
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Work Address (number/street/apt.) |
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Home Phone |
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D.O.B. |
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Place of Birth (Village or Town, City, State, Country)
N/A
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Home Address (number/street/apt.) |
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ZIP |
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D.O.B. |
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Place of Birth (Village or Town, City, State, Country) |
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N/A |
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Home Address (number/street/apt.) |
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Page 7
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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).
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Page 8
c.List
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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 |
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If “Yes”, |
Other ___________________ |
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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
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Employer’s Telephone Number:
City, State and Zip Code
Reason for leaving employment:
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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.
- Obtain the Form: Ensure you have the APD-5A form and two copies.
- Fill Out Personal Information: Start with your surname, first name, and middle initial at the top of the form.
- Enter Identification Details: Provide your social security number, exam number, and list number. Use black ink.
- 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.
- List Any Aliases: Include nicknames or maiden names as needed with the reasons for their use.
- Body Art Information: Indicate whether you have tattoos, brands, or piercings, and describe them.
- Complete Personal Data: Provide your sex, date of birth, and birth certificate information.
- Citizenship Details: Confirm your U.S. citizenship status. If applicable, provide details about naturalization.
- Resident Alien Card: Complete the section if you have this card, including its expiration date.
- Passport Information: Indicate whether you have a U.S. passport and provide the necessary details.
- Travel History: List countries outside the U.S. that you have visited, including dates and duration of stay.
- Marital Status: Mark your current marital status and provide details of your spouse or registered domestic partner if applicable.
- Residence Record: List all past and current addresses, including temporary ones, in chronological order.
- Family Information: Document details of living or deceased children, including custody information and parental details.
- Family Record and References: Include full names and addresses of family members, such as parents and grandparents.
- Complete Remaining Sections: Fill out any additional information requested in later sections of the form.
- Notarize the Form: After fully completing both copies, have them notarized in the designated section.
- 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.
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