Fillable CAS-19 REQUEST FOR CANDIDATES EMPLOYMENT RECORD Date (City of New York)

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CAS-19 REQUEST FOR CANDIDATES EMPLOYMENT RECORD Date (City of New York)

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The CAS-19 REQUEST FOR CANDIDATES EMPLOYMENT RECORD Date (City of New York) form is 2 pages long and contains:

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  • 5 check-boxes
  • 72 other fields

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File type: PDF

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THIS IS AN INQUIRY CONCERNING: Exam No.___________ List No._________
Name Address
Employed By You As From To
Social Security No. Date Of Birth
I hereby give my written consent and request and authorize you to turn over any and all employ-
ment records relating to my employment.
I acknowledge by this authorization that I release you from any obligation or liability in the disclo-
sure of the contents of such fi les and the professional observations or opinions contained therein.
I further request that such records be forwarded to the Police Department Investigator, named
below.
Candidate’s Signature
Social Security Number
The above named person is a candidate for the position of ______________________________ in
the Police Department of the City of New York and states that he/she was employed by you in the capacity and
for the period(s) shown above.
I have been assigned by the Police Commissioner to investigate the character and record of
this candidate in order to determine his/her eligibility for the position.
You can assist this department in its effort to appoint competent persons of good character
if you will furnish the information requested on the reverse side of this letter. All information will be treated as
confi dential.
Your cooperation and prompt reply will be greatly appreciated.
REQUEST FOR CANDIDATE’S
EMPLOYMENT RECORD
PD 407-163 (Rev. 08-19)
CAS-19
Rank/Name Squad No. E-mail Address
Date
Attention: Personnel Records
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signature
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NAME OF FIRM OR AGENCY TYPE OF BUSINESS OR FUNCTION OF AGENCY DATE
EMPLOYED PART TIME AVERAGE
OR
FROM TO FULL TIME TITLE OR DUTY WEEKLY SALARY SOCIAL SECURITY NO.
IF NOT PRESENTLY EMPLOYED BY YOU, INDICATE MANNER OF LEAVING YOUR EMPLOY
(Check One)
RESIGNED VOLUNTARILY (State reason given.)__________________________________________________
REQUESTED TO RESIGN (State reason.)_______________________________________________________
DISCHARGED _______________________________________________________________
LAID OFF ________________________________________________________________
OTHER ________________________________________________________________
CANDIDATE’S EMPLOYMENT RECORD (Check yes or no. If you desire to elaborate, do so in “details.”)
Honest Yes Amenable Yes Excessively Yes Was He Ye s
No To Orders No Late No Ever No
Disciplined
Sober Yes Able To Get Yes Excessively Yes Injured or Ye s
No Along With No Absent No Given First No
Others Aid
IS SUBJECT CONSIDERED Yes WOULD YOU PREFER A PERSONAL Ye s
“ELIGIBLE FOR REHIRE”? No INTERVIEW TO DISCUSS THE CANDIDATE? No
DETAILS OR ADDITIONAL COMMENT:
RESIDENCE
ADDRESSES WHILE
IN YOUR EMPLOY
NAMES AND
ADDRESS
OF PREVIOUS
EMPLOYERS
SIGNATURE TITLE OF YOUR POSITION YOUR BUSINESS TELEPHONE NO.
REQUEST FOR CANDIDATE’S EMPLOYMENT RECORD
Please
specify
reason
}
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CAS-19 REQUEST FOR CANDIDATES EMPLOYMENT RECORD Date (City of New York)

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Completed 17 December 2020

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