APD 5A Form – Fill Out and Use This PDF

The APD 5A form is a detailed questionnaire required by the New York City Police Department for civilian title applicants. It covers a complete personal history, including background, familial relations, and other relevant personal details, used to assess suitability for the role applied for. Answering every question thoroughly and truthfully is essential, as it directly shapes the hiring decision. If you are ready to take the next step in your application process, click the button below to fill out your APD 5A form.

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APD-5A Form PDF Details

The APD 5A form is the official personal history questionnaire for candidates seeking civilian titles with the New York City Police Department. Also known as the NYPD CAS-5A or CAS 67 form, it collects a wide range of personal information including identification details, citizenship status, residential history, employment background, familial connections, and social media presence. The document spans 24 pages and must be completed using black ink throughout.

Applicants must complete every field with precision and accuracy, leaving no question blank. The NYPD uses this information to conduct thorough background checks, ensuring that every candidate meets the strict integrity standards required for public service roles. Any omission or inaccuracy in the submitted record can result in disqualification from the selection process.

This questionnaire is one of several background documentation requirements for civil service candidates in New York City. You may also need a background check consent form to authorize the review process, or an employment reference check form for verifying your professional history. If you are applying in another state, the Texas Personal History Statement follows a comparable structure for civil service background documentation.

Question	Answer
Form Name	APD-5A Form (NYPD CAS-5A)
Form Length	24 pages
Fillable?	No
Fillable fields	0
Avg. time to fill out	6 min
Other names	CAS 67 form, NYPD telephone reference check, NYPD CAS form, NYPD CAS 67

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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

How to Edit Apd 5A Form Online for Free

Filling out the APD 5A form (also called the NYPD telephone reference check or CAS 67 form) is straightforward with FormsPal. Our platform makes completing any form online easy. Follow the steps below to get started.

Step 1: Click the orange "Get Form Now" button to open the document in the FormsPal editor.

Step 2: Use the multifunctional toolbar to fill in fields, add text, highlight sections, and make any needed corrections. The editor supports all standard PDF annotations.

These areas make up the key sections of the document:

In Part I (Personal Data), complete the Last Name, First Name, Middle Initial, Social Security Number, any prior legal name changes, court index numbers, marriage dates, aliases, tattoos or brands, sex, and date of birth fields as required.

In the Citizenship section, provide your country of birth, date of entry if not born in the USA, naturalization certificate number and court details if applicable, and your US Resident Alien card number and expiration date if applicable.

In the Travel History section, list all countries visited outside the USA, the town or city visited, dates, length of stay, and purpose of visit. Note whether any visa has ever been denied. Initial the page to confirm that you have read and understood it.

Complete the Spouse or Registered Domestic Partner section with home address, city, state, ZIP code, date of birth, occupation, home phone, work phone, work address, cell phone, and email.

Step 3: Click Done when you have finished reviewing all fields. You can then export the completed document to your device or send it directly to an email address.

Step 4: Make a copy of the completed document for your records before submitting. FormsPal does not store or share your personal data.

Frequently Asked Questions

What is the APD 5A form used for?

It is the official personal history questionnaire used by the New York City Police Department to vet candidates for civilian positions. It collects background information, employment history, residential records, and personal references so the NYPD can conduct a thorough review before making a hiring decision.

Who needs to complete this form?

Any person applying for a civilian title within the NYPD must complete it as part of the applicant processing procedure. This includes administrative, technical, and support roles across NYPD departments. Sworn officer candidates use a separate set of application documents.

How long does it take to complete?

The document spans 24 pages and most applicants spend 30 to 60 minutes completing it once they have the required information ready. Before you start, gather your Social Security number, current and past addresses for the last 10 years, employment history, and names and contact details for family members.

What happens if I make an error?

Do not use correction fluid. Draw a single line through the error, write the correct information directly above it, and initial the change. The NYPD requires that all corrections are visible and signed. Covering an answer may cause your application to be rejected.

Are there related forms I may need?

Depending on your application, the NYPD may request additional supporting documents. A background check consent form authorizes the department to verify your records with external agencies. You may also be asked to provide an AFP police check form if you have lived or worked outside the United States.

APD 5A Form – Fill Out and Use This PDF

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