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Blank Apd 5A PDF Form

The APD 5A form is a personal history questionnaire used by the New York City Police Department for civilian job applicants. This form collects essential information regarding the applicant's background, including personal data, residence history, and family records. It is crucial for candidates to complete the form accurately and return it promptly to avoid any delays in the hiring process.

To ensure your application is processed smoothly, fill out the APD 5A form by clicking the button below.

Article Guide

The APD 5A form is an essential document for individuals applying for civilian positions within the New York City Police Department. This form collects a comprehensive personal history from applicants, including vital information such as names, social security numbers, and citizenship status. Applicants must complete the questionnaire in black ink and submit two notarized copies to their assigned investigator. The form emphasizes the importance of accuracy, requiring applicants to answer all questions truthfully and completely. If any question does not apply, applicants should indicate so clearly. Additionally, the form includes sections for personal data, residence history, and family records, ensuring that a thorough background check can be conducted. It also outlines the penalties for providing false information, reinforcing the seriousness of the application process. Given that civil service lists remain valid for only four years, timely submission of the APD 5A form is crucial for candidates hoping to secure employment. Furthermore, the New York City Police Department is committed to equal opportunity, welcoming applicants from diverse backgrounds.

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	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

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.

Sex: Male  Female 

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

4.Birth Certificate:

Certificate Number

City or Town

County

State

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? ___________________________________________________________________________

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

Yes 

No 

Expiration: __________________

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

Alien Registration No. __________________________________________________

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	D.O.B.			Occupation


	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	D.O.B.			Occupation


	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	D.O.B.			Occupation


	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	D.O.B.			Occupation


	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

➤ PDF File

Form Specifications

Fact Name	Description
Form Purpose	The APD-5A form is used by applicants seeking appointment to civilian titles within the New York City Police Department. It collects essential personal history information.
Submission Requirements	Applicants must complete two copies of the form, notarize them, and return them to their assigned investigator. It's crucial to answer all questions completely and truthfully.
Legal Consequences	Under New York State Civil Service Law, providing false information can lead to severe penalties, including rejection or revocation of appointment.
Validity of Civil Service Lists	Civil Service lists generated from this form remain valid for up to four years. After expiration, candidates cannot be appointed from that list.
Equal Opportunity Employment	The New York City Police Department adheres to equal opportunity employment principles, ensuring fair treatment for all applicants.

Apd 5A: Usage Guidelines

Completing the APD 5A form is an essential step in your application process. This form requires detailed personal information, and accuracy is crucial. After filling out the form, you will need to ensure that both copies are notarized and submitted to your assigned investigator as instructed.

Begin by writing your surname, first name, and middle initial at the top of the form.
Fill in the exam number and list number as indicated.
Provide your social security number in the designated space.
Use black ink to answer all questions, ensuring clarity and legibility.
Answer the personal data questions, including your legal name change if applicable, and provide details about any tattoos or body art.
Indicate your sex and date of birth accurately.
Complete the section regarding your birth certificate and citizenship, providing all necessary details.
Answer questions about any U.S. Resident Alien Card or passport you may hold.
List all countries you have traveled to, including dates and purposes of visits.
Detail your marital status and provide information about your spouse or registered domestic partner, if applicable.
Complete the residence record section, listing all addresses you have lived at, including temporary ones.
Provide information about your children, including their names, birth dates, and custody details.
List your parents and any step-parents, including their complete addresses.
If needed, use pages 18-22 for additional information and indicate the question number.
Initial each page to confirm that the information provided is complete and accurate.
After filling out both copies, have them notarized in the space provided on page 18.
Return the completed and notarized forms to your assigned investigator as directed.

Your Questions, Answered

What is the purpose of the APD-5A form?

The APD-5A form serves as a personal history questionnaire for individuals applying for civilian positions within the New York City Police Department. This form collects essential personal information, including name, social security number, citizenship status, and residence history. The information provided helps the department conduct background checks and ensure that applicants meet the necessary qualifications for employment. Completing the form accurately and thoroughly is crucial for a successful application process.

How should I complete the APD-5A form?

When filling out the APD-5A form, applicants must use black ink and ensure that all answers are printed clearly. It is important to answer every question, even if the answer is "N/A" or "NONE" for questions that do not apply. If additional space is needed, applicants can use the provided pages 18 through 22. Mistakes should only be corrected by drawing a single line through the error and initialing next to it. Using correction fluid or leaving questions blank is not permitted, as this may lead to complications in the application process.

What happens if I provide false information on the APD-5A form?

Providing false information on the APD-5A form can have serious consequences. Both New York State Civil Service Law and the Personnel Rules of the City of New York impose penalties for making false statements or engaging in deceptive practices during the application process. Such penalties can include rejection of the application, revocation of an appointment if already hired, and potential legal prosecution. Therefore, it is vital for applicants to answer all questions truthfully and to the best of their ability.

What should I do if I have questions while completing the APD-5A form?

If you encounter any questions or uncertainties while completing the APD-5A form, it is advisable to seek assistance. You may contact your assigned investigator for clarification on specific sections of the form. Additionally, reviewing the instructions provided with the form can help address common concerns. Ensuring that you understand each question fully will aid in providing accurate and complete information, thereby enhancing your chances of a successful application.

Common mistakes

Using Incorrect Ink Color: One common mistake is filling out the form in ink colors other than black. The instructions clearly state that answers must be printed in BLACK INK. Using blue or any other color can lead to complications in processing your application.
Leaving Questions Blank: Some applicants mistakenly leave questions unanswered. Every question must be addressed. If a question does not apply to you, indicate this by writing “N/A” or “NONE.” Leaving a question blank can result in delays or even rejection of your application.
Incorrectly Correcting Mistakes: When errors occur, applicants often use correction fluid or other methods to amend their mistakes. However, the form specifies that mistakes should only be corrected by drawing a single line through the error and initialing it. Using correction fluid can invalidate your application.
Insufficient Detail: Providing vague or incomplete answers can hinder your application. For instance, when asked about tattoos or other body art, applicants must include detailed descriptions, including their meanings. Failing to provide adequate information may raise questions about your honesty or thoroughness.
Ignoring Notarization Requirements: Many applicants overlook the requirement to have the form notarized. Both copies of the questionnaire need to be notarized before submission. Failure to do so can lead to your application being deemed incomplete.

Documents used along the form

The APD 5A form is a crucial document used by the New York City Police Department for civilian appointments. Alongside this form, several other documents may be required to complete the application process. Below is a list of commonly associated forms and documents, each described briefly for clarity.

Background Investigation Release Form: This document authorizes the police department to conduct a background check on the applicant, including criminal history and previous employment verification.
Fingerprint Card: Applicants must submit a fingerprint card to facilitate a thorough background check. This card captures the applicant's fingerprints for identification purposes.
Medical Examination Report: A medical examination report is required to confirm that the applicant meets the physical and mental health standards necessary for the position.
Proof of Citizenship: This document serves as verification of the applicant's citizenship status. Acceptable forms include a birth certificate or a naturalization certificate.
Social Security Card: A copy of the applicant's Social Security card is needed to verify identity and eligibility for employment.
Educational Transcripts: Applicants may be required to submit official transcripts from educational institutions to verify their educational qualifications.
Resume: A current resume detailing work history, skills, and qualifications may be requested to provide a comprehensive overview of the applicant's background.
Personal References: A list of personal references is often required. These individuals can vouch for the applicant's character and work ethic.
Affidavit of Residency: This document confirms the applicant's current residency and may be necessary to establish eligibility for local employment.
Driver’s License: A copy of the applicant’s driver’s license may be needed to confirm identity and address, especially if driving is a requirement of the position.

Each of these documents plays a vital role in ensuring a comprehensive evaluation of applicants for positions within the New York City Police Department. Properly completing and submitting these forms can significantly impact the appointment process.

Similar forms

APD-5B Form: This document is also a personal history questionnaire for applicants. Similar to the APD-5A, it requires detailed personal information, including residency and family history. Both forms emphasize the importance of honesty in responses.
Background Investigation Form: Used by various agencies, this form collects comprehensive information about an applicant's history. Like the APD-5A, it includes sections on personal data, residences, and family, ensuring a thorough evaluation of the candidate.
Employment Application: This form gathers information about a candidate's work history and qualifications. While it focuses more on employment details, it shares the requirement for accurate and complete responses, similar to the APD-5A.
Personal Reference Form: Often required during hiring processes, this form seeks input from individuals who can vouch for the applicant's character. Both forms aim to paint a complete picture of the candidate, relying on truthful disclosures.
Medical History Questionnaire: This document collects health-related information from applicants. Like the APD-5A, it necessitates full disclosure to assess fitness for duty.
Security Clearance Application: Used for positions requiring access to sensitive information, this application gathers extensive personal and professional details. Both documents prioritize transparency and accuracy in the applicant's history.
Credit History Disclosure: This form assesses the financial background of applicants. While it focuses on credit, it parallels the APD-5A in its insistence on complete and truthful information.
Affidavit of Identity: This legal document verifies the identity of an individual. Similar to the APD-5A, it requires accurate personal details and may be used in conjunction with other forms during the hiring process.
Social Media Disclosure Form: This form requires applicants to disclose their social media presence. Like the APD-5A, it seeks to ensure that candidates provide a comprehensive view of their identity and background.

Dos and Don'ts

When filling out the APD 5A form, it is crucial to adhere to specific guidelines to ensure a smooth application process. Here are five important do's and don'ts to keep in mind:

Do print your answers in black ink. This ensures clarity and uniformity in your application.
Do complete both copies of the questionnaire. You must notarize both copies before submission to your assigned investigator.
Do provide complete answers. If a question does not apply to you, indicate this by writing “N/A” or “NONE.”
Do correct mistakes appropriately. Use a single line to cross out errors and add your initials at the end.
Do submit your documents promptly. Delays could affect your chances for appointment, especially since civil service lists expire after four years.

Don't leave any question blank. Every question must be answered to avoid potential rejection of your application.
Don't use correction fluid. Mistakes should only be corrected as specified to maintain the integrity of your application.
Don't provide false information. Misrepresentation can lead to serious consequences, including rejection or prosecution.
Don't forget to initial each page. This indicates that you have reviewed and confirmed the accuracy of your information.
Don't ignore deadlines. Failing to appear for scheduled appointments can jeopardize your chances for appointment.

Following these guidelines will not only help you complete the APD 5A form correctly but also enhance your prospects for a successful application. It is essential to approach this process with care and attention to detail.

Misconceptions

Misconceptions about the APD 5A form can lead to confusion and mistakes in the application process. Here are nine common misconceptions explained:

It's optional to provide complete information. Many applicants believe they can skip questions or leave them blank. In reality, every question must be answered. If a question does not apply, write “N/A” or “NONE.”
Corrections can be made freely. Some think they can use correction fluid or erase mistakes. However, errors should only be corrected by drawing a single line through the mistake and initialing it. Using correction fluid is strictly prohibited.
Notarization is not necessary. Some applicants may overlook the requirement for notarization. Both copies of the questionnaire must be notarized before submission, ensuring the information is verified.
Only one copy is needed. A misconception exists that only one completed questionnaire is required. In fact, two copies must be filled out and submitted.
All questions are straightforward. Applicants may assume that all questions are easy to answer. However, some questions, especially regarding legal names or citizenship, may require additional documentation or thought.
It's okay to provide vague answers. Some believe that general answers are sufficient. To avoid issues, it’s crucial to provide detailed and accurate information, especially about tattoos, legal names, and travel history.
There are no consequences for false statements. Many applicants underestimate the seriousness of providing false information. Making false statements can lead to severe penalties, including rejection or prosecution.
Submission deadlines are flexible. Some candidates think they can take their time with submissions. However, the Civil Service lists are valid for only four years, making timely submission essential.
Family information is optional. Applicants may think they can leave out family details. However, complete family records, including living and deceased relatives, are required.

Understanding these misconceptions can help applicants navigate the APD 5A form process more effectively and avoid potential pitfalls.

Key takeaways

Key Takeaways for Filling Out and Using the APD 5A Form

Complete the form using black ink and ensure all answers are printed clearly.
Submit two copies of the completed form, both of which must be notarized.
If additional space is needed, use pages 18-22 and reference the question number.
Indicate "N/A" or "NONE" for questions that do not apply; do not leave any question blank.
Correct mistakes by drawing a single line through the error and initialing next to it; avoid using correction fluid.