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Form preview Cdcr 998 timesheet form OFFICE OF PEACE OFFICER SELECTION CDCR 1902 Rev. 11/2012 CALIFORNIA DEPARTMENT OF CORRECTIONS AND REHABILITATION PERSONAL HISTORY STATEMENT CONFIDENTIAL INSTRUCTIONS FOR COMPLETING THE PERSONAL HISTORY STATEMENT Document must be typed. Handwritten documents will not be accepted. Complete all required fields if nothing applies input N/A to move to the next question. Use Section 17 Supplemental Page to expand on any answers. All employees regardless of assignment shall be clean and well groomed. Specific personal grooming standards pertaining to facial hair hair length hair color fingernails cosmetics and jewelry can be found in the Department Operations Manual Chapter 3 Section 33020. 6. 1. NO HOSTAGE POLICY The CDCR has a no hostage policy. The policy states Employees must not permit inmates or others to use hostages to escape from custody or otherwise interfere with orderly institutional operations. Hostages will not be recognized for bargaining purposes. All inmates visitors and staff will be informed of this regulation. USE OF FORCE POLICY The CDCR has a use of force policy. As a peace officer you may be required to use a variety of reasonable force techniques to ensure the safety and security of the institution in which you work. This could range from the use of verbal instructions and orders to the use of firearms. If the need arises in the course of your employment as a peace officer to shoot another human being would you refuse or delay doing so for personal political religious or other reasons or delay doing so for personal political religious or other reasons I certify that I have read and understand the above information and policies. ISSUING CITY/STATE CITATION REASON CONVICTED OF CONVICTED OF Have you been the driver in a motor vehicle accident within the past 7years DATE OF INJURY ACCIDENT CITED POLICE AGENCY NAME ACCIDENT POLICE INVESTIGATE CITED SECTION 13 INMATE/PAROLEE/GANG ASSOCIATION/MEMBERSHIP Corrections and Rehabilitation Have you any family relative or friend ever been the victim of a violent crime in which the offender was/is currently an inmate or ward under the jurisdiction of the California Department of Corrections and Rehabilitation INMATE/PAROLEE S FRIEND/RELATIVE/ASSOCIATE S NAME OF INMATE/WARD/PAROLEE PRISON NUMBER NAME OF PRISON/FACILITY INCARCERATED OR PAROLED DATES To and From RELATIONSHIP TO YOU Has any of your friends family or relatives ever been a member of or associated with a street or prison gang Have you ever attended a gathering function or party of a street or prison gang overthrow of the United States Government or the State of California by force or violence or any unlawful means Are you willing to take an oath to support the United States Constitution and the California State Constitution SECTION 14 GENERAL QUESTIONS Have you used a fake ID or the ID of another person Did you omit lie or commit fraud on any documents you submitted for evaluation for a peace officer position with CDCR Are you freely willing to work split shifts nights weekends and holidays as a CDCR peace officer SECTION 15 CERTIFICATION OF UNDERSTANDING GROOMING STANDARDS The CDCR has a grooming standard for Peace Officers. All employees regardless of assignment shall be clean and well groomed. Specific personal grooming standards pertaining to facial hair hair length hair color fingernails cosmetics and jewelry can be found in the Department Operations Manual Chapter 3 Section 33020. Personal History Statements must be notarized. See page 2. Please submit the following documents along with the Personal History Statement o Certified United States Birth Certificate or Original Naturalization Certificate Documents reflecting any name changes from your Birth Certificate. This includes marriage certificates divorce decrees court adoption documents etc. Certified and Sealed High School Transcripts or Certified proof of GED or passing California High School Proficiency exam DD214 Military Discharge documents Member 4 long form if you served in the Military. Copy of current/valid automobile insurance Current dated within 30 days of turning in documents Credit Report from one of the following Experian Equifax Transunion Professional License or Credential if applicable to position I have read and fully understood the instructions LOCATION AND CONTACT INFORMATION Northern Field Office 9838 Old Placerville Road Suite B Sacramento CA 95827 916 255-2500 Central Field Office 2510 S. East Avenue Suite 360 Fresno CA 93706 559 445-5770 9055 Haven Avenue Suite 100 Rancho Cucamonga CA 91730 909 944-6676 AUTHORIZATION TO RELEASE INFORMATION PLEASE SIGN AND INITIAL THIS DOCUMENT IN THE PRESENCE OF A NOTARY PUBLIC A photocopy of t his A uthorization t o Release Information shall be as binding as t he original and will be sent t o all employers and law enf orcement agencies during the course of the background investigation under the authority of California Government Code 1031.

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