Page * of * MTAPD Form – **

(Revised */**)

Metropolitan Transportation Authority

POLICE DEPARTMENT

CANDIDATE APPLICATION

Instructions: The CANDIDATE APPLICATION shall be prepared by a Member applying for a position for which the MTA Police Department is seeking candidates: Applicants must:

A. Complete all applicable sections indicating “N/A” for those sections that do not apply. B. Attach additional pages as necessary.

C. Forward the completed abstract to WKH 0HPEHU V immediate supervisor who shall FRPplete applicable sections and then forward through the chain of command. D. Notify Commanding Officer of the position for which WKH 0HPEHU is applying for of any changes to residence and contact numbers.

Position Applied For: Name: Rank: Current District/Unit: Location: Tour: RDO: Home Address: (Street, Apt#): City/Town/State: Zip: Home Phone: Date of Hire: Cell Phone: Employee Identification Number: 1. In chronological order, provide your history of employment with the MTA Police Department. 2. List by date and type, any special assignments (other than uniform assignments) in which you have served. Begin with MTA PD assignments followed by other law enforcement assignments if applicable. 3. List by date, all colleges attended, major courses of study and degrees attained. Page 2 of 9 MTAPD Form – 69

(Revised 2/19)

CANDIDATE APPLICATION

PROMOTIONAL EXAMINATIONS

List the last two promotional examinations you have taken YEAR SGT OR LT PASS/FAIL FINAL GRADE LIST POSITION 4. List by date, training (other than in-service training) and/or technical schools which you have attended. Page 3 of 9 MTAPD Form – 69

(Revised 2/19)

CANDIDATE APPLICATION

5. Do you have any skills or abilities which may be beneficial to the position for which you are applying (e.g., foreign languages, computer skills, electronic background, etc.)? 6. By date, briefly describe specific note-worthy investigations and arrests concluded successfully during your career. For each incident, please confirm if you were the arresting officer. Page 4 of 9 MTAPD Form – 69

(Revised 2/19)

CANDIDATE APPLICATION

7. Commendations: List by date, all commendations you have received during your career. Briefly describe each. Page 5 of 9 MTAPD Form – 69

(Revised 2/19)

CANDIDATE APPLICATION

8. Complimentary Letters: List by date, letters received which compliment the successful performance of your duties. Attach copies.

9. Disciplinary Actions: List by date, all disciplinary actions against you during your career. Briefly describe each incident.

10. Complaints: List by date, all complaints that have been made against you. Briefly describe each event. Page 6 of 9

MTAPD Form – 69

(Revised 2/19)

CANDIDATE ABSTRACT FOR NONCOMPETITIVE MEMBER POSITIONS 11. APPLICANT FAMILY MEMBER DISCLOSURE FORM

Do you have a relative or a member in your household employed at MTA or any of MTA’s Subsidiaries or Affiliated Agencies (including MTA New York City Transit, MTA Long Island Rail Road, MTA Capital Construction Company, MTA Bridges and Tunnels, MTA Bus Company, MTA Metro-North Railroad, the Manhattan and Bronx Surface Transit Operating Authority and the Staten Island Rapid Transit Operating Authority)? Yes No

If yes, please indicate the individual(s) below to identify any potential conflict of interest. Last Name, First, MI MTA Agency Work Address Relationship Job Title 12. ADDITIONAL REMARKS: Use this section to explain why you are interested in this position and to inform us of any other pertinent information.

I AFFIRM, subject to the penalty of dismissal, that the statements made above (including statements made in any accompanying papers submitted by me) have been examined by me and to the best of my knowledge and belief, are true and complete. I understand that any omission, misrepresentation, or falsification in my response to any of the questions in the application may be cause for rejection and/or disciplinary action, including dismissal, after appointment. MEMBER’S SIGNATURE: DATE: Page 7 of 9 MTAPD Form – 69

(Revised 2/19)

CANDIDATE ABSTRACT FOR NONCOMPETITIVE MEMBER POSITIONS SUPERVISORY & COMMAND STAFF COMMENTS

Supervisor’s Name: Candidate Abstract for (Insert Member’s Name): COMMENTS FROM FIRST LINE SUPERVISORS: Consideration is given to the below listed VNLOOV. Please provide examples for each of these areas:

Has the candidate demonstrated an ability to plan, lead, direct, regulate and coordinate the work of others? Please provide examples.

How does the candidate display the ability to work with limited supervision? Please provide examples. Describe in detail, providing specific examples, the candidate’s report writing skills and abilities, including knowledge of all department reports and other law enforcement paperwork. Describe in detail investigative skills displayed by candidate. Please provide examples. Page 8 of 9 MTAPD Form – 69

(Revised 2/19)

CANDIDATE ABSTRACT FOR NONCOMPETITIVE MEMBER POSITIONS SUPERVISORY & COMMAND STAFF COMMENTS

To Be Completed By Immediate Supervisor:

How long have you directly supervised the Member? Additional comments: (Attach additional sheets as necessary.) SUPERVISOR’S NAME: (Print) RANK: SIGNATURE: DATE: To Be Completed By Next Level Supervisor:

How long have you directly supervised the Member? Yes No

Yes No

Yes No

Yes No

Is the abstract complete?

Have you checked the incidents for accuracy?

Have you consulted with the initial reviewing supervisor? Does the Member deserve consideration for the position? Explain:

Do you agree or disagree with the initial reviewing supervisor’s evaluation? Please explain. COMMENTS: (Attach additional sheets as necessary.) SUPERVISOR’S NAME: (Print) RANK: SIGNATURE: DATE:

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Page 9 of 9 MTAPD Form – 69

(Revised 2/19)

CANDIDATE ABSTRACT FOR NONCOMPETITIVE MEMBER POSITIONS SUPERVISORY & COMMAND STAFF COMMENTS

COMMANDING OFFICER’S COMMENTS: (Attach additional sheets as necessary.) COMMANDING OFFICER SIGNATURE: Date: B__ REGIONAL CHIEF COMMENTS: (Attach additional sheets as necessary.) REGIONAL CHIEF SIGNATURE: Date:

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Contact this candidate