Harris County Precinct Constable’s Office Precinct 6 Personal History Statement
Harris County Constable’s Office Precinct 6
333 Lockwood
Houston, Texas 77011
Background Application
HARRIS COUNTY CONSTABLE’S OFFICE, PRECINCT SIX
BACKGROUND APPLICATION
AND
PERSONAL HISTORY STATEMENT
APPLICANT’S NAME:
LAST, FIRST M.I.
DATE OF APPLICATION
COMPLETE AND RETURN BY
I am applying for:
[ ] Peace Officer PID#______
[ ] Telecommunicator PID#______
[ ] Civilian Employment ______
Personal History Statement Instructions
Employees are exposed to confidential and law enforcement sensitive information. A thorough background investigation is required to properly evaluate the suitability of applicants for employment with the agency. Although it is an achievement to reach the background phase of the hiring process, this is still a competitive process and does not, in any way, guarantee selection.
These instructions are provided as a guide to assist you in properly completing your Personal History Statement. It is essential that the information is accurate in all respects so please read all instructions carefully before proceeding. The Personal History Statement will be used as a basis for a background investigation that will determine your eligibility for becoming an employee.
1. Your application must be printed legibly in BLACK INK by the applicant or typed. Answer all questions truthfully and accurately.
2. If a question is not applicable to you, enter N/A in the space provided.
3. Avoid errors by reading the directions carefully before making any entries on the form. Be sure your information is accurate and in proper sequence before you begin.
4. If you need additional space for your answers, attach an additional sheet or sheets as needed. Be sure to indicate what question number and page the additional information refers to.
5. An accurate and complete form will help expedite your investigation. Omissions or falsifications will result in disqualification.
6. You are responsible for furnishing any changes and/or updating your application as needed, such as address changes or telephone changes in writing.
7. Incomplete applications WILL NOT BE CONSIDERED. Application will be evaluated on completeness and neatness.
8. If you have any questions, please contact a supervisor
9. When submitting the completed documents, please place them in a sealed envelope marked “Personal and confidential” and give to Ms. Solis, the Constable’s Assistance.
Applicant Qualification Section
Before you begin to fill out this personal history statement, please ensure that you meet the following requirements. You must meet all seven of these requirements to qualify for licensure as a peace officer or jailer in Texas.
Initial: / ______I am available to work rotating shifts, including evenings, nights weekends, and holidays.______I have completed FTO training.
______I am ARS, DIMS, and JIMS competent.
______I familiar with TCIC/NCIC Guidelines.
______I have no attendance or tardiness issues.
______I have no ARS tardiness issues.
WORK REFERENCES
List (3) co-workers or supervisors who know you well enough to provide information about you.
Name______Years known______
Telephone #______
Name______Years known______
Telephone #______
Name______Years known______
Telephone #______
HARRIS COUNTY PRECINCT 6 HISTORY
1. How long have you held a commission with Harris County Precinct Constable’s Office? ______
2. How many TCLEOSE training hours do you currently have? ______
3. What level of TCLEOSE certification do you have? ______
4. I am bilingual in the ______language.
5. Have you ever been investigated by Internal Affairs. Yes______No______
If you answer yes, please provide a brief explanation.______
______
______
______
______
6. Have you received any commendations? Yes______No______
If you answered yes, please provide a brief explanation.______
______
______
______
______
DISQUALIFICATION
Deliberate misstatements or omissions can and often will result in your application being rejected, regardless of the nature or reason for the misstatements/omissions.
Attendance or ARS tardiness issues that cannot be explained or justified is cause for automatic disqualification.
I hereby certify that there are no misrepresentations, omissions, or falsifications in the foregoing statements and answers to the above questions. I fully understand that any misrepresentation, omission, or falsification may deem me permanently unsuitable, or if hired, may lead to the termination my employment.
Applicant’s Signature Date
Before me personally appeared who stated this document and its intent was explained to him/her that he/she has full knowledge of its purpose and that he/she executed this instrument of his/her free will and accord.
Sworn to and subscribed before me on this day of ,
______
( SEAL ) Signature of Notary
My Commission Expires: ______
NOTARIZED AUTHORIZATION FOR RELEASE OF PERSONAL INFORMATION
I, , do hereby authorize a review and full disclosure of any and all records, medical records, files, photographs and notes or other historical record concerning myself the undersigned and identified individual to any duly authorized agent of the Harris County Constable’s Office, Precinct Six, Houston, Texas, whether the said records, medical records, files, photographs and notes or other historical record are of a public, private or confidential nature.
The intent of this authorization is to give my consent for a full and complete disclosure of the records of educational institutions, financial or credit institutions including records of loans, records of commercial and or retail credit agencies (including credit reports and / or ratings); and other financial statements and statements wherever filed; medical and psychiatric or psychological treatment and / or consultation, including hospitals, clinics, private practitioners, and the U.S. Veteran’s Administration, employment and pre-employment records, including background reports, efficiency ratings or evaluations, complaints or grievances filed by or against me and the records and recollections of Attorneys at Law, or of other counsel whether representing me or another person in any other case, either criminal or civil, in which I presently have, or have had an interest. It is my further intent to waive any attorney client privilege that I may have had now or in the past.
I understand that any information obtained by a personal history background investigation which is developed directly or indirectly, in whole or in part, upon this Release Authorization will be considered in determining my suitability for employment or appointment by the Harris County Constable’s Office Precinct Six or by Harris County, Texas. I also certify that the person(s) who may furnish such information concerning me shall not be held accountable for giving or providing such information; and I hereby explicitly release said person(s), organizations or any other entity from any and all liability which may be incurred as a result of furnishing such information.
I also agree to pay for any and all charges and fees concerning this request and can be billed for such charges at the below listed address.
A photocopy of this Release form will be valid as if it were the original thereof, even though said photocopy does not contain an original writing of my signature.
______
Signature of applicant Social Security Number Date of Birth
______
Printed full name of applicant Address
______
Date Signed City State Zip Code
SWORN to and SUBSCRIBED before me, the undersigned authority, on this the ______day of ______, 20_____.
Notary Public in and for the State of Texas
______
( SEAL ) Signature of Notary
My Commission Expires:
5
CD6 - 11/07/13