Form APD-19 at a glance
What it is: APD-19 is the Request for Applicant's Employment Record, PD 407-163 (Rev. 2-09).
Who signs: Sign on the Applicant's Signature line and enter the Social Security Number. The person the applicant "was employed by" signs.
The investigator is assigned by the Police Commissioner to investigate the character and record of this applicant in order to determine his/her eligibility for the position.
A filled-in Form APD-19 example: an applicant requests a past employer's record
How to fill out Form APD-19, box by box
Date and this is an inquiry concerning
Enter the Date.
Enter the Exam No. and List No.
Enter the Name and Address.
Enter Employed By You As, From and To.
Enter the Social Security No. and Date Of Birth.
Applicant's signature and consent
I hereby give my written consent and request and authorize you to turn over any and all employment records relating to my employment. I acknowledge by this authorization that I release you from any obligation or liability in the disclosure of the contents of such files and the professional observations or opinions contained therein. I further request that such records be forwarded to the Police Department Investigator.
Sign on the Applicant's Signature line and enter the Social Security Number.
Position of the applicant
The named person is an applicant for the position 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.
Rank/Name, Squad No. and E-mail Address
Enter Rank/Name, Squad No. and E-mail Address.
Page 2: Name of firm or agency
The person the applicant "was employed by" enters the NAME OF FIRM OR AGENCY, the TYPE OF BUSINESS OR FUNCTION OF AGENCY and the DATE, if that person will furnish the information requested at the reverse side of this letter.
Employed from and to, title or duty, weekly salary
Enter EMPLOYED FROM and TO, PART TIME OR FULL TIME, TITLE OR DUTY, AVERAGE WEEKLY SALARY and SOCIAL SECURITY NO.
Manner of leaving your employ
If not presently employed by you, indicate manner of leaving your employ (Check One).
For RESIGNED VOLUNTARILY, state reason given.
For REQUESTED TO RESIGN, state reason.
For DISCHARGED, please specify reason.
For LAID OFF, please specify reason.
For OTHER, please specify reason.
Candidate's employment record
Check yes or no. If you desire to elaborate, do so in "details."
Check Yes or No for Honest, Amenable To Orders, Excessively Late and Was He Ever Disciplined.
Check Yes or No for Sober, Able To Get Along With Others, Excessively Absent and Injured or Given First Aid.
Check Yes or No for IS SUBJECT CONSIDERED "ELIGIBLE FOR REHIRE"? and WOULD YOU PREFER A PERSONAL INTERVIEW TO DISCUSS THE CANDIDATE? Write DETAILS OR ADDITIONAL COMMENT.
Residence addresses and names and address of previous employers
Enter RESIDENCE ADDRESSES WHILE IN YOUR EMPLOY.
Enter NAMES AND ADDRESS OF PREVIOUS EMPLOYERS.
Signature, title of your position and business telephone no.
The person the applicant "was employed by" signs on the SIGNATURE line and enters TITLE OF YOUR POSITION and YOUR BUSINESS TELEPHONE NO., if that person will furnish the information requested at the reverse side of this letter.
Sources
[1] Form APD-19 (PD 407-163 Rev. 2-09), Request for Applicant's Employment Record, New York City Police Department (the Official source link on this page).