Maryland Polygraph Police Form PDF Details

The Maryland State Police Applicant Polygraph Screening Booklet serves as a critical piece in the employment process, designed to ensure the utmost honesty and integrity among potential hires. Aimed at positions ranging from Trooper and Cadet to Civilian and Allied Agency roles, this comprehensive document begins by ascertaining a candidate's serious intent through a conditional offer of employment query. Probing further, it establishes a strong foundation for truthfulness, explicitly stating the significance of candid responses for a role within law enforcement where trust and responsibility are paramount. A detailed personal background check forms the cornerstone of this process, meticulously examining facets such as identity, citizenship, residency, and more, calling for absolute transparency regarding past actions and affiliations, including any legal alterations to personal identity or instances of holding citizenship in countries other than the United States. Additionally, the form ventures into the domains of residency stability and moral conduct, interrogating potential evictions, financial delinquencies, and interpersonal disputes, aiming to sketch a comprehensive moral and ethical portrait of the applicant. This scrutiny underscores the rigorous standards upheld by the Maryland State Police, ensuring that each candidate's integrity is thoroughly vetted through a polygraph examination before any commitments are made, reflecting the department's diligent approach to fostering a trustworthy and reliable law enforcement body.

QuestionAnswer
Form NameMaryland Polygraph Police Form
Form Length29 pages
Fillable?No
Fillable fields0
Avg. time to fill out7 min 15 sec
Other namesmd polygraph state police, maryland state police polygraph, msp form polygraph screening printable, maryland form polygraph

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Assigned to: _____________________

Tracking 67# ____________________

MARYLAND STATE POLICE APPLICANT POLYGRAPH SCREENING BOOKLET

Position Applied For:

Trooper Cadet

Civilian

Allied Agency

Other_

Have you received a written Conditional Offer of Employment? Yes No

INSTRUCTIONS TO APPLICANT:

You are being considered for employment with the Maryland State Police. As a prerequisite for employment, you are required to submit to a pre-employment polygraph examination. As part of that process, it will be necessary for you to complete this booklet. The contents of this booklet are held "CONFIDENTIAL," except when essential to the conduct of proper official police business and national security. It is important that you understand that the intentional misrepresentation, omission, or falsification of any material fact may be just cause for disqualification or dismissal from the applicant process.

Maryland State Police employees, regardless of position, are placed in a position of trust and responsibility. Because of this trust, the MSP expects candor and honesty from all employees. The purpose of this examination is to determine the truthfulness of the information provided to the polygraph examiner. The areas of inquiry will deal with your background and experience.

During the interview with the polygraph examiner, you will discuss many aspects of your background. Some may seem so "bad" that you are afraid it will disqualify you from this job. What will disqualify you is your failure to provide truthful, accurate, and complete information.

The next page is your written permission for the examiner to administer your examination. Do not mark on the page except to sign it in the lower right corner marked "signature."

Name (Last, First Middle) ________________________________________________________

Date of Birth_____________ Driver's License Number / State ____________________________

Mailing Address _______________________________________________________________

City ________________ County ______________ State __________ Zip Code ___________

Telephone: Home________________ Work _______________Cell Phone ________________

E-mail address ________________________________________________________________

Current Employer ______________________________________________________________

Employment Address ___________________________________________________________

City ________________ County ______________ State __________ Zip Code ___________

Date Booklet Completed: ___________________

MSP 40-23 (09-16)

1

RELEASE

I hereby voluntarily submit to a polygraph examination (detection of deception) by the Maryland State Police. I understand and agree that the polygraph examination will be audio and video recorded and that the recordings as well as the results of the polygraph examination may be made available to the proper authorities. In consideration of being given a polygraph examination without cost to me, I, for myself, my heirs, personal representatives and assigns, hereby agree to hold harmless, the Maryland State Police, its officers, employees, and agents from any liability for any damage to me as a result of said examination and I hereby remise, release, waive, and forever discharge and exonerate said Maryland State Police, its officers, employees, agents from any and all action or cause of action, claim, or demand which I have now or may ever have resulting directly, indirectly, or remotely from said examination or making known any reactions, statements, information, and incidental opinions made by me as part of the examination.

In witness whereof, I have hereunto set my hand and seal the day and date set forth above.

_________________________________

____________________________

WITNESS

SIGNATURE / DATE

MSP 40-23 (09-16)

2

SECTION A: PERSONAL BACKGROUND INFORMATION

PART 1: IDENTITY

Full Name: (Last, First Middle):____________________________________________________________________

Date of Birth: _________________ Race:________ Gender:_________ Place of Birth: _____________________

Social Security Number: _________________________________________________________________________

Scars, marks, or tattoos: (explain any significance) ____________________________________________________

_____________________________________________________________________________________________

Excluding nicknames, list any other names you have ever used and the periods of time you used them:

_________________________________________________________________________________________________

YES NO

1.

2.

3.

4.

5.

6.

7.

8.

9.

Has your name ever been changed by court order?

Have you ever used a false name, date of birth, or place of birth for any reason? Have you ever obtained, possessed, or used any form of false identification? Have you ever used a false Social Security Number or someone else’s SSN? Have you ever misrepresented your identity to any law enforcement agency? Have you ever falsified your identity on any job application?

Have you ever falsified your identity on any credit application?

Have you ever falsified your identity on any other application or official document?

While underage, did you ever use any type of false identification to buy alcoholic beverages?

WRITTEN EXPLANATIONS FOR ANY “YES” ANSWERS TO SECTION A, PART 1 - IDENTITY:

_________________________________________________________________________________________________

_________________________________________________________________________________________________

_________________________________________________________________________________________________

_________________________________________________________________________________________________

_________________________________________________________________________________________________

_________________________________________________________________________________________________

_________________________________________________________________________________________________

MSP 40-23 (09-16)

3

SECTION A: PERSONAL BACKGROUND INFORMATION (Continued)

PART 2: CITIZENSHIP

YES NO

____ ____ Have you ever held citizenship in any country other than the United States?

IF YOU ANSWERED “YES” TO THE ABOVE QUESTION, YOU MUST ALSO ANSWER THE BELOW QUESTIONS ON THIS PAGE. IF YOU ANSWERED “NO” TO THE ABOVE QUESTION, YOU DO NOT HAVE TO ANSWER THE BELOW QUESTIONS ON THIS PAGE. PROCEED TO SECTION A, Part 3 (page 6).

Excluding the United States, list all foreign countries where you have held citizenship and the periods of time for each:

_________________________________________________________________________________________________

In what country were you born?________________________________________________________________________

At what age did you leave your country of birth? _________ At what age did you come to the U.S.?_______

Why did you leave your country of birth?_________________________________________________________________

Why did you come to the U.S.?________________________________________________________________________

With whom did you come to the U.S.?___________________________________________________________________

To what country do you hold your primary allegiance (loyalty)? _______________________________________________

YES NO

1.

2.

3.

4.

5.

6.

7.

Have you ever worked for a foreign government or foreign law enforcement agency? Have you ever been a member of a foreign military service?

Have you ever worked for, or been affiliated in any way, with a foreign intelligence agency? Are you now a Naturalized United States Citizen?

Have you provided this department with a valid Naturalization Certificate? Do you possess a valid passport issued by a foreign country?

Have you taken part in committing any crime(s) in another country?

WRITTEN EXPLANATIONS FOR ANY “YES” ANSWERS TO SECTION A, PART 2 – CITIZENSHIP:

_________________________________________________________________________________________________

_________________________________________________________________________________________________

_________________________________________________________________________________________________

_________________________________________________________________________________________________

_________________________________________________________________________________________________

_________________________________________________________________________________________________

MSP 40-23 (09-16)

4

SECTION A: PERSONAL BACKGROUND INFORMATION (Continued)

PART 3: RESIDENCY

List your current home address: _______________________________________________________________________

List any other addresses where you stay on a regular basis: _________________________________________________

_________________________________________________________________________________________________

 

YES

 

NO

1.

 

 

 

 

 

 

 

Have you ever been evicted or threatened with eviction from any places you have lived?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

2.

 

 

 

 

 

 

 

Have you ever had a mortgage foreclosure taken against you?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

3.

 

 

 

 

 

 

 

Excluding eviction or foreclosure, have you ever been ordered to vacate any place you have lived?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

4.

 

 

 

 

 

 

 

Have you ever been forced to vacate housing at any colleges due to disciplinary problems?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

5.

 

 

 

 

 

 

 

Have you ever received a notice to appear in Landlord-Tenant Court?

 

 

 

 

 

 

 

6.

 

 

 

 

 

 

 

Do you reside at any other address on a regular basis?

 

 

 

 

 

 

 

 

 

 

 

 

 

7.

 

 

____

 

 

____

 

Have you ever broken a lease at any place you lived?

 

 

 

 

 

8.

 

 

 

 

 

 

 

Have any liens been placed against any property you have owned?

 

 

 

 

 

 

 

9.

 

 

 

 

 

 

 

Have you had any police contact while leasing or renting?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

10.

 

 

 

 

 

 

Have you been involved in any arguments or fights with any of your neighbors?

 

 

 

 

 

 

11.

 

 

 

 

 

 

Will any of your current or former neighbors say anything derogatory about you?

 

 

 

 

 

 

 

 

 

 

 

 

12.

 

 

 

 

 

 

Have you ever moved out of any place you have lived due to arguments or disputes with your spouse,

 

 

 

 

 

 

 

 

 

 

 

 

 

 

family members, roommates, neighbors, or landlords?

WRITTEN EXPLANATIONS FOR ANY “YES” ANSWERS TO SECTION A, PART 3 - RESIDENCY:

_________________________________________________________________________________________________

_________________________________________________________________________________________________

_________________________________________________________________________________________________

_________________________________________________________________________________________________

_________________________________________________________________________________________________

_________________________________________________________________________________________________

_________________________________________________________________________________________________

_________________________________________________________________________________________________

MSP 40-23 (09-16)

5

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