BUFFALO GROVE POLICE DEPARTMENT
BACKGROUND INVESTIGATION MANUAL
It is the policy of the Buffalo Grove Police Department that all
personnel activities shall be conducted in a manner that will assure
equal employment opportunity for all persons on the basis of merit,
without regard to political affiliation, race, color, religion, national
origin, sex, marital status, age or other non-merit factors. This policy
shall extend to all personnel practices related to the employment
process, promotions, demotion, transfer, lay-off, termination,
compensation, benefits, training and general treatment of employees.
Revised 11/01/05
TABLE OF CONTENTS
PERSONAL INFORMATION
EMPLOYMENT/CREDIT
MILITARY
EDUCATION
REFERENCES
CONTINUATION SHEETS
CERTIFICATION STATEMENT
IMPORTANT INSTRUCTIONS - READ CAREFULLY
The following information is extremely important for you to read and understand. The background
investigation phase of the selection process is very important. Your full cooperation is expected. It is
recommended you read this entire booklet completely prior to filling it out so as not to miss anything.
Read every question carefully. Answer each question. Leave no blank spaces at all. Provide complete
names, include middle name or initial. Addresses must include zip codes. Telephone numbers must
include area codes. You, as the applicant, are required to obtain all this information and print it legibly in
black ink. You are responsible for personally preparing the booklet and compiling all copies of the
required document. In the event more space is required use a separate sheet of paper.
This background investigation and its results are strictly confidential and are the sole property of the
Buffalo Grove Police Department. All copies of documents provided by the applicant become the sole
property of the Buffalo Grove Police Department and will not be returned.
Copies required:
(at time you submit background booklet)
1.
One copy of your birth certificate.
2.
One copy of your current marriage license, if applicable.
3.
One copy of your divorce decree(s) and applicable papers, if applicable.
4.
One copy of your military discharge form DD214, if applicable.
5.
One copy of your high school diploma or GED equivalent. If unable to provide a diploma copy,
obtain a letter of certification from the school graduated.
6.
One copy of EACH college degree(s) you have achieved, including certified transcripts from each
institution.
7.
One copy of ANY and ALL education certificates you have ever achieved, which includes ANY
field of study.
8.
One copy of ANY civil litigation you have been involved in, past or currently pending.
9.
One copy, both sides, of your current driver's license.
Applicants should note that the above copies (if applicable) are required. It is your responsibility as the
candidate to obtain and supply these copies to the investigating officer.
The candidate is also encouraged to provide copies of any information or certificates of achievement you
feel may be worthwhile to the investigating officer. Basically if you are not sure, copy it and bring it in.
CONFIDENTIAL MATERIAL FORM
BUFFALO GROVE POLICE DEPARTMENT
I understand that any background investigation, including a physical examination, which may be
made, consists of confidential material, which will not be released to me. Furthermore, I hereby authorize
you to contact former employers as part of this background investigation. Copies of this authorization
may be provided to such employers and said copies may be treated as if they were signed originals.
_____________________________________
Police Candidate
_____________________________________
Witness
_____________________________________
Date
1.
Applicant full name:
(last, first, middle)
2.
Give any other name(s) you have been known by or used and explain reason, include maiden
name(s) if applicable:
3.
Place of birth:
(name of hospital, clinic, etc)
(city, county, state, country)
4.
Date of birth:
month, date, year (00/00/0000)
5.
Birth certificate number:
(supply city, county, state, and country where certificate is on file.)
6.
Social security number:
(000-00-0000)
7.
Place of residence:
(street address)
(apartment #, city, state, zip code)
8.
With whom do you reside:
Their relationship to you:
9.
Home phone number:
(000)000-0000
Work number:
(000)000-0000
Cell Number:
(000)000-0000
E-Mail:
10.
In chronological order, state every place you have resided:
FROM
MONTH
YEAR
(00)
(0000)
11.
TO
MONTH
YEAR
(00)
(0000)
CITY
STATE
List all the places you have registered to vote or voted. If none, state so:
COUNTY
12.
STREET ADDRESS
STATE
YEAR
(0000)
List all traffic tickets you have received and all arrests (juvenile and adult) that occurred in this or
any other state. EXPLAIN ALL CRIMINAL ARRESTS IN DETAIL below:
DATE
(00/00/0000)
VIOLATION OR
CHARGE
CITY/STATE/COUNTY
Explain all Criminal arrests above in detail:
COURT
DISPOSITION
POLICE AGENCY
YOUR
AGE
13.
Were you EVER summoned or subpoenaed to court in a civil action in this state or elsewhere, OR
could such a possibility ensue as a result of a recent occurrence or transaction?
Yes
No
If YES, indicate below EVERY civil action or proceeding in which you were a party to, past
and/or present. Also if YES, please EXPLAIN ALL ENTRIES IN DETAIL BELOW:
DATE
(00/00/0000)
ACTION OR
PROCEEDING
PLAINTIFF-DEFENDANT
WITNESS-RESPONDENT
COURT DISPOSITION
Explain all entries in detail:
14.
Have you ever owned or do you now own any firearm? Yes
No
If so, list makes, models, serial numbers, caliber and description.
MAKE
MODEL
SERIAL NO.
CALIBER
DESCRIPTION
15.
Do you possess an IL Firearm Owners Identification Card? Yes
16.
If so, what is your Firearm Owners ID Number:
17.
Have you ever had a Firearms Owner ID Card application rejected for any reason?
Yes
No
If an application was rejected, why?
Have you ever had a Firearms Owner ID Card revoked for any reason? Yes
No
18.
No
If yes, why?
19.
Are you native born or a naturalized citizen? Native Born
Naturalized
20.
Are you currently using drugs illegally?
21.
Have you ever used prescribed drugs not prescribed to you? Yes
If yes, please explain.
22.
Do you consume any alcoholic beverages? Yes
23.
Are you single, married, divorced, a widow(er):
24.
Give following information regarding ALL marriages:
DATE
Yes
No
No
No
COUNTY & STATE
SPOUSE NAME & DATE OF BIRTH
(maiden name if applicable)
(00/00/0000)
25.
Are you living with your spouse now? Yes
26.
Were you EVER legally OR voluntarily separated from your spouse?
27.
Were you EVER divorced? Yes
28.
If EVER separated OR divorced, indicate which, and fill in required information.
SEPARATED,
DIVORCED
DATE OF DECREE
(00/00/0000)
No
No
If no, state reason:
Yes
If yes, how many times?
BY WHOM
COUNTY, STATE
WHERE ISSUED
GROUNDS FOR
DIVORCE,
SEPARATION
29.
Were you ever the parent of ANY children, whether alive or deceased? Yes
30.
List below EVERY child you are a parent of, natural or adopted.
NAME
(first, middle, last)
31.
DATE OF BIRTH
(00/00/0000)
No
PLACE OF BIRTH
(city, state, county)
No
WITH WHOM AND
WHERE DOES CHILD
RESIDE
Are you now supporting all children you are a parent of, including natural, adopted, and
stepchildren? Yes
No
If no, state details:
32.
List below ALL real estate owned by you or in which you have ANY financial interest, starting
with your primary residence (give full company names, addresses with zip codes, and phone
numbers with area codes.):
ADDRESS
33.
TOTAL MORTGAGE
Are you renting your home now? Yes
MONTHLY
PAYMENT
No
ADDRESS/PHONE OF
MORTGAGE HOLDER
If yes, give detailed information as follows:
Monthly rent:
Landlord (full name, address with zip code, area code/phone number):
34.
If you possess or have possessed any of the following, complete the required information in full:
ITEM
NUMBER
STATE, COUNTY, COUNTRY OF
ISSUE
Driver’s license
Vehicle license plates
35.
Was your driver's license EVER suspended or revoked? Yes
No
If yes, explain:
Date of action:
County and state and country of action:
Basic reason for action:
36.
Were your vehicle license plates EVER suspended or revoked? Yes
date of action
No
If yes,
If yes, explain in detail:
37.
Have you ever been involved in a motor vehicle accident either as a registered owner, operator,
passenger or pedestrian, which resulted in any personal injury, property damage, or fatality to you
or anyone else?
Yes
No
If yes, give full details (including city and state where occurred and police agency
making any reports on incident:
38.
Have you ever been fingerprinted? Yes
DATE
39.
If yes, fill in the following:
WHERE
PURPOSE (Be specific)
Indicate below all life insurance policies ever issued in your name:
COMPANY
40.
No
ADDRESS
DATE ISSUED
00/00/0000
List all hobbies and special interests you have:
AGE WHEN
ISSUED
RESIDENCE AT
ISSUE
41. Give the name of your father, mother (married and maiden names), sisters, brothers, aunts,
uncles, below along with other required information (immediate relatives). Include their relationship
to you, i.e. father, mother, uncle, etc.:
NAME & RELATIONSHIP
AGE
FULL HOME ADDRESS AND PHONE
42.
What is your current occupation?
43.
State current monthly income:
44.
List below and on following pages, earliest dates first, EACH AND EVERY place in which you
were or are now employed. OMIT NONE. Include all part time employment. GIVE
CORRECT, FULL NAMES OF PERSONS AND BUSINESSES, GIVE CORRECT FULL
ADDRESSES WITH ZIP CODES FOR EMPLOYERS, AND GIVE CORRECT, FULL PHONE
NUMBERS WITH AREA CODES FOR EACH AND EVERY EMPLOYER, PAST AND
PRESENT.
NAME, ADDRESS, PHONE OF
DATES
EMPLOYER
(00/00/0000)
NAME
FROM
ADDRESS
TO
CITY, STATE, ZIP
PHONE
NAME
FROM
ADDRESS
TO
CITY, STATE, ZIP
PHONE
NAME
FROM
ADDRESS
TO
CITY, STATE, ZIP
PHONE
NAME
FROM
ADDRESS
TO
CITY, STATE, ZIP
PHONE
SALARY
POSITION
NAME OF
REASON FOR
SUPERVISOR
LEAVING
NAME
FROM
ADDRESS
TO
CITY, STATE, ZIP
PHONE
NAME
FROM
ADDRESS
TO
CITY, STATE, ZIP
PHONE
NAME
FROM
ADDRESS
TO
CITY, STATE, ZIP
PHONE
NAME
FROM
ADDRESS
TO
CITY, STATE, ZIP
PHONE
NAME, ADDRESS, PHONE OF
DATES
EMPLOYER
(00/00/0000)
NAME
FROM
ADDRESS
TO
CITY, STATE, ZIP
PHONE
NAME
FROM
ADDRESS
TO
CITY, STATE, ZIP
PHONE
NAME
FROM
ADDRESS
TO
CITY, STATE, ZIP
PHONE
NAME
FROM
ADDRESS
TO
CITY, STATE, ZIP
PHONE
NAME
FROM
ADDRESS
TO
CITY, STATE, ZIP
PHONE
SALARY
POSITION
NAME OF
REASON FOR
SUPERVISOR
LEAVING
NAME
FROM
ADDRESS
TO
CITY, STATE, ZIP
PHONE
NAME
FROM
ADDRESS
TO
CITY, STATE, ZIP
PHONE
NAME
FROM
ADDRESS
TO
CITY, STATE, ZIP
PHONE
NAME
FROM
ADDRESS
TO
CITY, STATE, ZIP
PHONE
NAME
FROM
ADDRESS
TO
CITY, STATE, ZIP
PHONE
45.
Were you ever discharged or asked to resign from employment? Yes
No
How many
times?
If yes, give details including the name and address of employer, the date, superior's
name and the reason:
46.
Were you ever subject to disciplinary action in connection with any employment? Yes
If yes, give details.
47.
Have you, or any corporation or partnership of which you are/were an officer, director or partner,
ever possessed a license or permit issued by any governmental agency (exclude driver's license)?
Yes
No
If yes, give details:
48.
Has any license or permit issued by any governmental agency (exclude driver's license) ever been
denied to you or any corporation, partnership, or other business of which you were an officer,
director, or partner? Yes
No
Has any such license or permit ever been revoked, cancelled,
or suspended? Yes
No
If yes to either, give details:
49.
Have you ever acted as a sponsor, voucher, character witness, or made any recommendations for
or concerning any person or premises to any municipal, state, federal agency in connection with
the issuance, revocation, or suspension of any license or permit, or for any other reason, for any
person or premises. Yes
No
If yes, give details:
50.
Have you ever applied for a civil service examination except the present one? Yes
If yes, state year, locality, position and results:
51.
Besides the Buffalo Grove Police Department, were you ever or are you now on ANY hiring list?
Yes
No
If yes, state year, position, number on list, and whether federal, state or local
(give specific name):
52.
Were you EVER rejected for any civil service position? Yes
No
No
No
If yes, give details:
53.
Have you EVER previously submitted an application for hiring by the Buffalo Grove Police
Department? Yes
No
If yes, state year, list number, application number, and results of
your filing the application:
54.
Have you ever been bonded? Yes
whom bonded and reason for bond):
55.
Have you ever been refused a bond? Yes
56.
List below ALL outstanding debts and obligations (be specific on purpose of loan or debt):
TOTAL
OWED
MONTHLY
PAYMENT
No
If yes, give complete details (amount of bond, by
No
If yes, give details:
TO WHOM OWED
(name,address,zip,phone)
PURPOSE OF LOAN/DEBT (be
specific)
57.
Are you a co-maker on any outstanding loans? Yes
58.
Have you ANY garnishment, wage assignment, or judgment pending against you at this time OR
have you had at any time in the past? Yes
No
If yes, give details:
59.
Have you EVER served in a military or naval organization of the United States of America?
Yes
No
60.
Have you EVER served in a military or naval organization of any foreign government?
Yes
No
If yes, give details.
61.
Were you EVER refused entry into any military or naval service? Yes
If yes, explain in detail:
62.
How many periods of active military service have you had (include drafts, enlistments, or recalls
to service)?
63.
List below period(s) of active service and type discharge:
FROM (MONTH/YEAR)
TO (MONTH/YEAR)
(00/0000)
(00/0000)
No
If yes, give details:
No
TYPE OF DISCHARGE
64.
Has your discharge or separation ever been corrected or changed? Yes
was nature of change?
No
If yes, what
65.
What was your home address at the time you entered military or naval service?
66.
What was your home address at time of military discharge or separation from military service?
67.
Give branch of military service you served in:
68.
Military rank held:
Service serial #:
69.
Explain ANY military or naval discharge(s) other than Honorable:
70.
Were you EVER court martialed, tried on charges, or were you the subject of ANY other
disciplinary action in the military? Yes
No
Number of times:
If yes, give all details
along with the dispositions:
71.
Are you now or were you ever an active or inactive member of any reserve forces of the United
States of America or any foreign government? Yes
No
If yes, state whether active or
inactive, branch, unit, your rank, and the dates of service:
72.
Are you now or were you ever a member of the National Guard? Yes
If yes, answer the following:
State:
Regiment:
Unit:
Rank:
From/To:
Type of discharge:
No
73.
List below ALL of the schools and colleges you have attended. Start with most recent:
*Include full names of schools and colleges, full addresses with zip codes and full phone numbers
for each school, including area codes.
FROM
TO
MONTH/YEAR
MONTH/YEAR
00/0000.
00/0000
SCHOOL
FULL ADDRESS,
LAST
ZIP & PHONE
GRADE OR
TERM
74.
What college degree (s) do you possess and from what institution?
75.
What professional license(s) do you possess? If any, where from?
76.
List ANY special schooling or training you have had or any special skills such as trade schools,
apprenticeships, etc. (List schools attended or courses completed with complete addresses, dates
and certificate of accomplishments awarded to you, be detailed).
77.
Since the age of 18 have you ever been a member of a social, labor or fraternal organization?
Yes
FROM
MONTH/YEAR
(00/0000)
78.
No
If yes, list below EVERY such organization.
TO
MONTH/YEAR
(00/0000)
NAME OF
ORGANIZATION
PHONE/ADDRESS
TYPE OF
ORGANIZATION
List below your current, immediate neighbors. List them by name, address/zip code, and home
phone number/area code. If you do not know your immediate neighbors, contact them and obtain
this information.
1.
2.
3.
4.
79.
Please list all character references excluding relatives. You must list at least six references.
NAME
ADDRESS
(include zip/phone)
LENGTH OF
ACQUAINTANCE
OCCUPATION
AGE
80.
Do you have ANY knowledge or information, in addition to that specifically called for in the
preceding questions which is or which may be relevant, directly or indirectly, in connection with
an investigation of your eligibility or fitness for a position with the Buffalo Grove Police
Department; including but not limited to knowledge or information concerning your character,
temperance, habits, employment, education, subversive activities, family associates and friends,
criminal record, traffic violations, residence, or otherwise?
Yes
No
If yes, give details:
I, __________________________________________________________________________
(applicant's printed full name)
personally read each and every question and answered each and every question in this background
investigation booklet and questionnaire, and I do solemnly swear that each and every answer is full, true,
and complete and correct in every respect.
I fully understand that failure to complete and return this background investigation booklet in every
respect as instructed and required may be cause for my removal from the Buffalo Grove Police
Department eligibility list and failure to submit all copies of required documents may also be cause for
my removal from the Buffalo Grove Police Department eligibility list.
APPLICANT'S FULL LEGAL SIGNATURE: ____________________________________________
DATE OF SIGNATURE: __________________________
______________________________________________________________________________
______________________________________________________________________________
NOTE:
Applicant must submit copies of documents including, but not limited to, birth
certificates, divorce papers, marriage licenses, military form DD 214, schools attended,
diplomas, and certificates relating to law enforcement seminars or schools, general
education certificates and diplomas, with the completed background investigation
booklet.
This background investigation booklet and any copies supplied for this background
investigation are the sole property of the Buffalo Grove Police Department and nothing
will be returned to the applicant.
Do not sign below this line until directed to do so.
______________________________________________________________________________
______________________________________________________________________________
DATE: _____________________________________
APPLICANT'S FULL SIGNATURE: __________________________________________________
INVESTIGATING OFFICER SIGNATURE: _____________________________________________