The Maryland Polygraph Police form is a document required for applicants seeking employment with the Maryland State Police. This form is essential for the pre-employment polygraph examination, which assesses the truthfulness of the information provided by candidates. Completing this form accurately is crucial, as any misrepresentation may lead to disqualification from the hiring process.
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The Maryland Polygraph Police form serves as a crucial component in the employment process for candidates seeking positions within the Maryland State Police. This comprehensive booklet outlines the necessary steps and requirements for applicants, including a pre-employment polygraph examination, which is designed to assess the truthfulness of the information provided. Applicants must complete various sections, including personal background information, identity verification, citizenship status, and residency history. Each section is meticulously crafted to ensure that all relevant details are captured, allowing the Maryland State Police to evaluate candidates thoroughly. The form emphasizes the importance of honesty and accuracy, making it clear that any misrepresentation could lead to disqualification. Furthermore, applicants are informed that the contents of the form are treated as confidential, safeguarding their personal information while also highlighting the trust and responsibility that come with being a member of law enforcement. By requiring applicants to disclose their background and experiences, the Maryland State Police aims to maintain a high standard of integrity within its ranks, fostering a culture of transparency and accountability.
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 ___________________________________________________________
Date Booklet Completed: ___________________
MSP 40-23 (05-17)
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, including but not limited to other law enforcement agencies, social service agencies and current or past employers. 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
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:
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SECTION A: PERSONAL BACKGROUND INFORMATION (Continued)
PART 2: CITIZENSHIP
____ ____ 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)? _______________________________________________
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:
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PART 3: RESIDENCY
List your current home address: _______________________________________________________________________
List any other addresses where you stay on a regular basis: _________________________________________________
YES
NO
Have you ever been evicted or threatened with eviction from any places you have lived?
Have you ever had a mortgage foreclosure taken against you?
Excluding eviction or foreclosure, have you ever been ordered to vacate any place you have lived?
Have you ever been forced to vacate housing at any colleges due to disciplinary problems?
Have you ever received a notice to appear in Landlord-Tenant Court?
Do you reside at any other address on a regular basis?
____
Have you ever broken a lease at any place you lived?
Have any liens been placed against any property you have owned?
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:
5
PART 4: EDUCATION
Name of High School Attended: ________________________________ Dates Attended: ______________________
Address: ______________________________________________________ Diploma Received: Yes
No
Highest Grade Completed: ______ Graduation Date: __________ High School Equivalency (GED): Yes
COLLEGES / UNIVERSITIES ATTENDED (Include name, address, # of credit hours, major, degree received)
13.
14.
15.
Were you ever suspended or expelled from any type of learning establishment for any reason? Did you ever have any adverse contact with high school security or school police?
Were you ever taken into custody or charged with any crimes by high school security or police? Did you ever have any adverse contact with college campus security or college police?
Were you ever taken into custody or charged with any crimes by campus security or police? Were you ever questioned as a suspect in any crimes by campus security or police?
Were you ever ineligible to return to any high school or college due to disciplinary reasons? Were you ever barred from entering the property of any high school or college?
Did you ever have any adverse contact with any resident assistants?
Were you ever required to appear before any college hearing board as a result of disciplinary action? Did you ever cheat on any exams, tests, assignments, projects, or papers in high school or college? Were you ever caught cheating in any educational or training environment?
Did you ever falsify your high school or college grades or grade point average? Did you ever falsify any information on your high school or college transcripts? Did you ever have any academic/disciplinary probations in high school or college?
WRITTEN EXPLANATIONS FOR ANY “YES” ANSWERS TO SECTION A, PART 4 - EDUCATION:
6
PART 5: EMPLOYMENT
Please list places of employment starting from most recent. Also include dates employed. (If needed, use additional space provided in the remark sections)
16.
17.
18.
19.
20.
_
Have you ever been fired from any job?
Have you ever been allowed to resign from any job in place of being fired?
Have you ever quit any job because you thought you were going to get fired?
Are you ineligible for rehire at any place of employment now?
Have you ever been denied any merit increases due to poor performance evaluations?
Have you ever been involved in any physical or verbal confrontation with any coworker, supervisor,
or customer?
Have you ever quit any job due to allegations of misconduct on your part?
Have you ever received any written disciplinary action on any jobs?
Have you ever been suspended (with or without pay) from any job?
Have you ever been investigated for any criminal acts against any of your employers?
Have you ever been involved in industrial or corporate espionage?
Have you ever committed any criminal acts against any of your employers or coworkers?
Have you ever deliberately violated any serious employment rules or regulations?
Have you ever deliberately violated any employment nondisclosure agreements?
Have you ever been denied employment due to adverse results of a background investigation?
Have you ever applied to any police department or law enforcement agency?
Have you ever been employed by any police department or other law enforcement agency?
Have you ever been rejected for employment by any police department or law enforcement agency?
Have you ever had any prior polygraph examination? If “Yes”, list when, where, and results.
Have you ever before made application for employment with the Maryland State Police? If yes, when,
what position, and what is the status of that application.
WRITTEN EXPLANATIONS FOR ANY “YES” ANSWERS TO SECTION A, PART 5 - EMPLOYMENT:
7
PART 6: FINANCES / CREDIT / LAWSUITS
Have you ever declared bankruptcy?
Have any court ordered financial judgments ever been taken against you? Have you ever had any property repossessed?
Have you ever had any accounts taken over by a collection agency? Are any of your current debts or bills 30 or more days delinquent? Have any liens been placed against any property you have owned?
Have you ever been sanctioned by the IRS or any state income tax agency? Do you have any alimony or child support obligations?
IF YOU ANSWERED “YES” TO ANY OF THE ABOVE QUESTIONS, STATE WHAT SPECIFIC ACTIONS YOU TOOK OR ARE NOW TAKING TO RESOLVE THESE FINANCIAL PROBLEMS.
Have your wages ever been garnished?
Has anyone ever sued you?
Have you ever sued anyone?
Have you ever received any out of court settlements?
Have any of your bank accounts ever been garnished or frozen?
WRITTEN EXPLANATIONS FOR ANY “YES” ANSWERS TO SECTION A, PART 6 - FINANCES / CREDIT / LAWSUITS:
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PART 7: MILITARY SERVICE
Have you ever served in any branch of the Unites States military? Have you ever been rejected by any branch of the military?
Have you ever served in, or attempted to enlist in, any branch of a foreign military? Have you registered for selective service?
IF YOU SERVED IN THE MILITARY (U.S. OR FOREIGN) YOU MUST ALSO ANSWER THE FOLLOWING QUESTIONS. IF YOU HAVE NOT SERVED IN THE MILITARY, YOU DO NOT HAVE TO ANSWER THE BELOW QUESTIONS AND CAN NOW PROCEED TO SECTION 8.
Did you receive an Honorable Discharge? (IF NO, EXPLAIN)
Were you ever court-martialed?
Did you ever receive any nonjudicial punishments (written or verbal reprimand, etc.)? Were you ever questioned as a suspect in any crimes by any U.S. or foreign military police? Did you ever have any adverse contact with any U.S. or foreign police?
Were you ever denied eligibility for re-enlistment?
Were you ever charged with any violations of the Uniform Code of Military Justice (UCMJ)? Have you ever altered a copy of your DD-214 during any pre-employment investigation?
WRITTEN EXPLANATIONS FOR ANY “YES” ANSWERS TO SECTION A, PART 7 - MILITARY SERVICE:
9
PART 8: DRIVER’S LICENSE / RECORD / ACCIDENTS
Have you ever operated a vehicle after consuming any intoxicating substance to the point of impairment?
Have you ever operated a vehicle after consuming any intoxicating substance to the point of intoxication?
Have you ever fled from, or attempted to elude, police while on foot or in a vehicle? Have you ever operated a motor vehicle knowing it was uninsured / unregistered? Have your license plates ever been confiscated by the police or MVA?
Has your vehicle insurance ever been canceled or denied renewal? Have you ever failed to appear in court as a result of any traffic ticket? Have you ever received any traffic tickets as a result of a traffic accident? Have you ever been involved in any law-suit as a result of a traffic accident? Have you ever been involved in a hit and run accident?
Have you ever lied to any police officers to try to get out of a traffic ticket?
Have you ever lied to a judge in traffic court?
Do you currently have any traffic or parking tickets for which you have not paid the fine or appeared in court for?
Have you ever had a driver’s license in any other state? If so, list the periods of time for each? Have you ever filed to have any violations expunged from your driving record? If so, explain.
List below all traffic stops in this state or any other state that resulted in you receiving any of the following: citations, written warnings, verbal warnings, Safety Equipment Repair Orders, red light tickets, speed camera tickets.
DATE
STATE
VIOLATION(S)
DISPOSITION
10
Completing the Maryland Polygraph Police form is an essential step in the pre-employment process for those seeking a position with the Maryland State Police. This form requires detailed personal information and consent for a polygraph examination. Following the instructions carefully will help ensure that all necessary information is provided accurately.
The Maryland Polygraph Police form is designed for individuals applying for employment with the Maryland State Police. It is a prerequisite for the pre-employment polygraph examination, which assesses the truthfulness of the information provided by the applicant. The form includes personal background information and a release agreement for the examination.
Anyone applying for a position with the Maryland State Police, including Trooper, Cadet, Civilian, or Allied Agency roles, must complete this form. It is required for those who have received a written conditional offer of employment.
Providing false information, omitting details, or misrepresenting facts can lead to disqualification from the application process or dismissal if already employed. The Maryland State Police expects honesty and candor from all applicants and employees due to the nature of their responsibilities.
Yes, the contents of the Maryland Polygraph Police form are considered confidential. However, this information may be disclosed when necessary for official police business or national security purposes.
During the examination, a polygraph examiner will ask questions related to your background and experiences. The focus will be on assessing the truthfulness of your responses. It is important to answer all questions truthfully, as any dishonesty may disqualify you from the process.
Yes, you must sign the form to give your written permission for the polygraph examination. The signature should be placed in the designated area on the form. Do not make any other marks on that page.
The examination will cover various aspects of your personal background, including identity, citizenship, and residency. Questions may include inquiries about any name changes, past citizenships, or issues related to your living situations.
Yes, if you answer "yes" to any of the questions on the form, you will have the opportunity to provide written explanations. This is important for clarifying any issues that may arise from your responses.
If you have concerns about the polygraph examination, it is advisable to discuss them with the Maryland State Police or the polygraph examiner prior to the test. They can provide you with additional information and address any questions you may have.
The examination will be audio and video recorded. The recordings, along with the results of the examination, may be shared with appropriate authorities as needed.
Inaccurate Personal Information: Providing incorrect details, such as your name, date of birth, or Social Security Number, can lead to disqualification.
Failure to Disclose Other Names: Not listing all the names you have used, including nicknames or maiden names, may raise red flags.
Omitting Significant Background Details: Neglecting to mention any past legal issues or employment discrepancies can be seen as dishonest.
Misunderstanding Citizenship Questions: Misinterpreting questions about citizenship can lead to incomplete answers, which may cause confusion.
Not Providing Written Explanations: If you answer "yes" to any question, failing to provide a detailed explanation can hinder your application.
Ignoring Eviction History: Not disclosing past evictions or housing issues could be considered a lack of transparency.
Inconsistent Residency Information: Listing addresses that do not match your provided employment or personal history can create suspicion.
Forgetting to Sign: Neglecting to sign the consent form at the end of the booklet can invalidate your application.
Providing Incomplete Contact Information: Failing to include accurate phone numbers or email addresses can hinder communication with the police department.
Rushing Through the Form: Not taking the time to carefully read and complete the form can lead to careless mistakes that affect your application.
When applying for a position with the Maryland State Police, several forms and documents accompany the Maryland Polygraph Police form. Each of these documents serves a specific purpose in the hiring and screening process. Understanding these forms can help applicants prepare adequately and ensure a smoother application experience.
These documents collectively contribute to a comprehensive evaluation of the applicant's background, skills, and suitability for a role within the Maryland State Police. Being prepared with these forms can significantly enhance the application process.
The Maryland Polygraph Police form is similar to the Employment Background Check form. Both documents serve to gather detailed personal information from applicants seeking employment. They require applicants to disclose their history, including previous employment, education, and any legal issues. The purpose of this information is to ensure that candidates meet the standards and requirements for the position they are applying for, particularly in sensitive roles like law enforcement.
Another document that shares similarities is the Pre-Employment Drug Screening Consent form. Like the polygraph form, this document is used as part of the hiring process for positions that require a high level of trust. Both forms aim to ensure the integrity and reliability of the applicant. While the polygraph examines truthfulness, the drug screening assesses the applicant's compliance with substance use policies, both crucial for maintaining workplace safety and trust.
The Personal History Statement is also comparable to the Maryland Polygraph Police form. This document collects comprehensive background information from applicants, including family history, criminal history, and financial status. Both forms emphasize the importance of honesty and accuracy in the information provided. They serve as tools for employers to assess the suitability of candidates for positions that require a high level of responsibility and ethical conduct.
Lastly, the FBI Criminal Background Check form is similar in purpose and function. This form is used to investigate an applicant's criminal history as part of the hiring process. It aims to ensure that individuals in sensitive positions do not have disqualifying criminal records. Both the FBI form and the polygraph form highlight the significance of trust and integrity in roles that involve public safety and law enforcement responsibilities.
When completing the Maryland Polygraph Police form, it is essential to approach the task with care and attention to detail. Below is a list of things you should and shouldn't do to ensure a smooth process.
Misconception 1: The polygraph examination is a test of truthfulness.
Many people believe that the polygraph itself can determine if someone is lying. In reality, the polygraph measures physiological responses, such as heart rate and blood pressure, that may indicate stress. It is not a definitive measure of truthfulness.
Misconception 2: You can pass the polygraph by simply staying calm.
Some individuals think that if they remain calm during the test, they will pass. However, the polygraph examiner is trained to interpret physiological responses. Even if someone appears calm, the examiner may still detect signs of deception based on the data collected.
Misconception 3: Providing honest answers guarantees you will be hired.
While honesty is crucial, it does not guarantee employment. The Maryland State Police may consider other factors, such as the overall background and experience of the applicant. A single honest answer may not outweigh other disqualifying factors.
Misconception 4: The information provided in the polygraph booklet is not important.
Some applicants may think the details in the polygraph booklet are insignificant. However, the Maryland State Police expects complete and accurate information. Misrepresentation or omission can lead to disqualification or dismissal from the hiring process.
When filling out the Maryland Polygraph Police form, applicants should keep the following key takeaways in mind: