CTORY Chief Administrator 1st Deputy Chief Administrator Sharon Fairley #001 TBA Chief of Staff Deputy Chief Administrator Moore, Annette #005 Hirsch, Steven #003 Deputy Chief Administrator Chief In vestigator Westensee, Jay #006 Deputy Chief Administrator Administrative Operations Weeden, William Carlos #004 Deputy Chief Administrator General Counsel TBA Coordinator of Investigations Stoutenborough, Andrea #013 Director of Community Outreach and Engagement Merritt, Larry #023 Assistant Commissioner Martinez, Katherine Staff Assistant Artis, Ramona Attorney Liss, Wendi ITSC Data Services Administrator IT Thomas, Kelly #201 Principal Programmer Analyst IT De, Santanu #202 Online Library\Staff DirectoryUPRA STAFF DIRECTORY STAFF DIRECTORY Page 2 Supervising Investigator Daun, Sherry #026 Supervising Investigator Dean, Bruce #016 Supervising Investigator Hitt, Mark #021 Supervising Investigator Hunt, Joshua #028 Supervising Investigator Olvera, Maria Elena #014 Supervising Investigator Querfurth, Patrick #012 Supervising Investigator Roberts, George #020 Supervising Investigator Serio, Alexis #022 Revised (2/2/2016) STAFF DIRECTORY Page 3 Revised (2/2/2016) Investigator Investigator Anaele, Benedict #1 15 Carter, Shykela #132 Investigator Investigator Chico, Alice #105 Cosey, Robert #111 Investigator Investigator 111 Davis, Lakeisha #130 Goldston, Michael #109 Investigator Investigator Hayes, Shannon #137 Killen, Brian #129 Investigator Investigator Kuykendoll, Anita #106 Lukas, James #1 17 Investigator Investigator Lyons, Kristi #123 Messenger, Veronica #108 Investigator Investigator Neal, Wilbert #131 Sanchez, Jessica #134 Investigator Investigator Sanders, Erica #113 Soto, Roberto #118 Investigator Investigator Webb, Maira #112 Wilson, Grace #110 STAFF DIRECTORY Page 4 Revised (2/2/2016) Investigator II Abbruzzese, William #170 Investigator II Bowens, Darren #124 Investigator II Clark, Tammy #175 Investigator II Davis, Theresa #138 Investigator II Delaney, Richard #128 Investigator II Franko, Linda #1 16 Investigator II Goodwin, Jeanne Alyse #127 Investigator II Hendricks, Ramona #140 Investigator II Jackson, Angela #119 Investigator II Jackson, Tyrone #160 Investigator II Jones, Vincent #141 Investigator II Kalantzis, Thomas #149 Investigator II Kamalick, Dennis #133 Investigator II Kobel, Daniel #136 STAFF DIRECTORY Page 5 Revised (2/2/2016) Investigator II Lett, Kelvin #120 Investigator II Morley, Chantall #159 Investigator II Neubeck, Daniel #154 Investigator II Nu?o, Oscar #142 Investigator II Oliveri, Caterina #152 Investigator II Prieto, Dennis #174 Investigator II Reynolds, Kymberly #126 Investigator 11 Richmond, Johnna #1 14 Investigator 11 Sheets, Frank #150 Investigator 11 Thomas, Artra #139 Investigator II Vazquez, Aurora #107 Investigator II White, LaKenya #122 Investigator II Williams, Tiffany #125 STAFF DIRECTORY Page 6 Revised (2/2/2016) Investigator I Addington, Marc #177 Investigator I Hill, Chantelle #172 Investigator I Mack, Gina #173 Investigator I Pfeifer, Adam #179 Investigator I Salinas-Lopez, Luis #176 STAFF DIRECTORY Page 7 Revised (2/2/2016) Timekeeper Kunke, Florian Paralegal 11 Leonard, Shannon Paralegal II Paralegal 11 Moore, Laniya Shah, Anish Intake Aide Clerk IV Stewart, Denise Hazbic, Amra Sr. Legal Personal Computer Operator O?Leary, Carol Property Custodian Casa?Misuraoa, Sharon Personal Computer Operator II Brurn?eld, Lucille Senior Data Entry Operator Brown, Danita Senior Data Entry Operator Howard, Mia Clerk 111 McGhee, APPLICANT QUESTIONNAIRE CHICAGO POLICE DEPARTMENT INSTRUCTIONS: Aster all Rhestions accuramy arTa commtar?? statements. PRINT all Information in Ink. List additiohal iniormalion in 1.NAME ADDRESS ISTREET NO.. NAME. CITY. ZIP Ra n1 5.50CIAL SECURITY NO. 7. DO YOU HAVE A VALID DRIVERS IF YES. GIVE NUMBER EYES KING 3. LIST ANY PHYSICAL DISABILITY OR DIEEAS YOU HAVE HAD OR CURREN ACTIVITIES REQUIRED OF THE POSITION FOR WHICH YOU ARE APPLYING. NA. NONE DATE Mali 193.1191. will be disquali?ed for any false 2. MAIDEN NAME 11. HOME TELEPHONE ND. 6. BUSINESS TELEPHONE NO. 08) 356?560 arks Sect?mn. Elam EST APPOI DO NOT WRITE IN THIS SECTION I GATOR #183000191 Zimm_+ CS ELIG LIST OF ASSIGNMENT 113 sou LY HAVE 55 VENT YOU FROM PERFORMING THE 9. DID YOU SERVE IN THE US. ARMED IF BRANCH OF SERVICE 10. DATE ENTERED ARMEDSERVICE ILLINOIS C-II C- HICHGU 9/85 4/40 TRADE BUSINESS SCHOOL 3: EIYEs m0 - A 11. DATE DISCHARGED 12; RANK AT '13. TYPE OF DISCHARGE DNA DNA DNA 14.ARE YOUAHIGH SCHOOL No. DID YOU IF No. HOW MANY YEARS OF SCHOOL DID YOU EYES EIYES FROM TO NAME OF SCHOOL CITY 3? STATE MOLJYR. YES- ND #8353?? ATTENDED marl t. IMERIENNE lmo STATE MI GERIA 9/75 5/80 . JUNIOR 3 COLLEGE ILLINOIS l" COLLEGE OR I 33 9/ Sq NO. EQLICE CI-IICREC IL. IF YOU NEED ADDITIONAL SPACE. INDICATE THE QUESTION YOU ARE ANSWERING. THEN CONTINUE YOUR ANSWER BELOW. CH CRO STHTE alaneasI-m (mom-Io IL. Iqo PaesEN-r MI EWIPLWEII: LooP CDLLEQE. 30.5 n11 TLIIBEMT FROM 9kg To 5m. IL-I?mlcol mam. MR. ?LoI-IrN-sm. DNA- LEAVINE: 4 2? ml ?4 24hr?? Imssk Em Sager ?xwgiqigfr CPD-62.200 (REV. 1/36) CONTINUE ON REVERSE APPLICANT QUESTIONNAIRE PAGE NAME ., EDI C: 15- LIST PRESENT PREVIOUS IN CHRONOLOGICAL ORDER FOR THE PAST 5 YEARS. START WITH THE PRESENT. EMPLOYER (MOST RECENT) POSITION FROM-MOJYR. TO-MOJYR. SMITH NETWORK SLIPERUIOOQ CI /37 PRESENT ?590953 IMMEDIATE SUPE SALARY FOR LEAVING IEOI AI @3th NAPEKVILLE I L- B. EMPLOYER POSITION FROM-MOJYR. . . 3 CATV of: Awh?oN SELLIRIW 0439662. IKE 5/89 a, ADDRESS IMMEDIATE SUPERVISOR SALARY REASON FOR LEAVING Ema N. ST. OF C. EMPLOYER ITION 5 sqsfem PARKING, IN PARKING, ATTEMDMI ?lm I 5187 ADDRESS IMMEDIATE SUPERVISOR SALARY REASON FOR LEAVING L/Mcacea IL. I. D. EMPLOYER ITION FROM-MOJYR. TO-MOJYR. IL. Ifnmgamw STLIIBENT I 4/1510 ADDRESS REASON FOR LEAVING Csa RR IBM TE I3 IMMEDIATE SUPERVISOR SALARY 5500 II IF YES. DEPAR 16- HAVE YOU EVEN-BEEN EMPLOYED FROM TO BY THE CITY OF A A EYES mo now I 17. HAVE YOU EVER BEEN DISQUALIFIED IF was, WHAT POSITION DATE DISQUALIFIED REASON FO ANY CAREER SERVICE POSITION EYES CL - - 18. LIST SPECIAL SKILLS, TRAINING. EXPERIENCE. SUCH AS TYPING, SHORTHAND. LANGUAGE SPOKEN. ETC. INDICATE LEVEL OF ABILITY OR SPEED. I GE RIRN LA Manages -. I I I 9:0 3? SPEAK I- UN CHER 3 WIN NELL- REACI I: Nam; FAIR OR I5 3- K. '1 STAND NELL- Rim: 2 WRITE IZAIL I19. LIST 3 RESPONSIBLE ADULTS WHO KNOW YOU WELL ENOUGH TO GIVE INFORMATION CONCERNING YOU. NAME ADDRESS (NO., STREET GI CITVJ OCCUPATION CRIMINAL. OE TDEQAETMEI-J .- ILLINOIS LIMWERSI I ?mm . REFERENCES CH- SINCE I HAVE SAFEOU kwe E- PROTEOT The: ELIILDIM I25 1 Q5..- GIE ALI/wws To smug AGAINST Decep?cnr: THE 0R THE Penna?m. AQAINST VIOLENILE at: min FGREMIJST Pam-?510 vu- IO ELIETI CLE . IF CUMEIBEREDJER RESPEOT Tm?; AKIEPLTS DP ALI. ADDITIONAL REIJIARKs NITII LA NPR 1.. L1 .IZL I WILL GCMETANTLII ELERLIELE As REQUIRED: my AND. DEDI ILA-TE EEPDRE C1er To M1 CIIOSELN PROCEEISIQ .N THE. (2171 OF OHIEAEQ bemgmey OBJECTIVE EDUCATION OBIS-4 - 121'99 OSISO - 0634 Sh kela S. Carts. To obtain a challenging position that will allow for growth and an opportunity to use and contribute my education and job experience. Chicago State University, Criminal Justice Dean?s List, Minority lntemship Program, Criminal Justice Association Bachelor of Science Degree, December 1999 Major G.P.A. 3.5/4.0, Cumulative G.P.A. 3.3/4.0 Whitney M. Young High School Debate Team, African-American History Club, Cheerleader Squad PROFESSIONAL EXPERIENCE 03/00 - Present 09I99 - 12199 05197 - 09/99 (Seasonal) 06l96 - 08/96 In SKILLS UHLICH HOME Case Manager Provide case management services to parenting wards of the state. Create service plans based on child needs. Conduct timely social investigtion. Coordinate family and sibling visits. Develop valuable relationships with internal and external agencies. Chicago, IL SULLIVAN HOUSE ALTERNATIVE HIGH SCHOOL Chicago. IL Intern Supervised participants of the atterschool program who were on probation. Counseled students and maintained attendance records. Attended court with Youth Development counselor on behalf of students. lnteracted with probation of?cers that visited the school. Conducted employment workshop for youths 14?18. AMERITECH Chicago, IL Technical Assistant Dispatched technicians to non-working phone lines. Organized and computed daily data for District managers. Updated time sheets and analyzed results. AMERITECH Chicago, IL Field Support Administrator Answered an average of 100 calls per day to provide good customer service in a timely manner. Processed complaints to management. Typing 65 Speedwriting 70 Microsoft Word, Word Perfect, Excel. References available upon request. APPLICANT QUESTIONNAIRE I - DO NOT WRITE IN THIS SECTION CHICAGO POLICE DEPARTMENT gm 0.23:2 INSTRUCTIONS: Answer all queshons accurately and completely. You will be dlsquali ed for any false Slaternenls. PRINT all information in ink. List a?ciitiohal Il1fgfm?II?OI] in Remarks Sectiqg; 1. NAME (LAST 2. IOEN NAME 41. HOME TELEPHONE NO. 3? 8274.3 2?71 ?SZLc?Z/?xfd . 7. DO YOU HAVE A VALID DRIVERS IF YES, GIVE NUMBER EYES 3. LIST ANY PHYSICAL DISABILITY 0 I HAVE HFID OR CURRENTLY HAVE THFIT WOULD PREVENT YOU FROM PERFORMING THE AGTIVITIES REQUIRED OF THE POSITION FOR WHICH YOU. ARE APPLYING. all?, I a 4 If Ill/y fr?/k?lfji gfqif/?Iff?g? 9,29? 9. DID YOU SERVE IN THE u.s. ARMED IF YES. BRANCH OF SERVICE 10. DATE NTEREDARMEDSER n: EIYEs EINO 3 11. DATE DISCHARGEO 12. RANK AT DISCHARGE OF DISCHARGE 14.ARE YOUAHIGH SCHOOL 5 IF NO, DID YOU IF NO. How MANY YEARS OF SCHOOL DID You EYES EINO EIYES gig OD ST I FROM TO AM 0 ATE. MOJYR. YES NO LAST HIGH I i?F?E?bao Vt/ tau/30?? &3 JUNIOR . 4 1 COLLEGE . ,77 COLLEGE OR [y UNIVERSITY 0112(- fix/1? f5 2/ 7 4 517 TRADE OR 7 5 BUSINESS SCHOOL ?#557- IF YOU NEED ADDITIONAL SPACE. INDICATE THE QUESTION YOU ARE ANSWERING, THEN CONTINUE YOUR ANSWER BELOW. I I a r- IIUhlo l. J II CPD-62.200 (Rev. 1/86) CONTINUE ON REVERSE APPLICANT QUESTIONNAIRE 2 NAME 115- LIST PRESENT 8? PREVIOUS EMPLOYMENT IN CHRONOLOGICAL ORDER FOR THE PAST 5 YEARS. START WITH THE PRESENT. AEMPLOYER (MOST RECENTI q_ POSITION 1251/ C3 la (57ng I 37? I ADDRESS IMMEDIATE SDISERVISOR REASON FOR LEAVINE: 5217/ ?06? hi2:- a B. EMPLOYER. 0 POSITION FROM-MOJYR. . - . 8.96717? gar Macy/c255 I 4/ 5 ADDRESS IMMEDIATE SUPERVISOR . 62? REASON FOR LEAVING 1A9 Ema/{W c. POSITION - TD7551? J11 -?5l5?7r..z ??cara/l?w :92" 5 ADDRESS SALARY FOR LEAVING - . I . . .- 16.; (Z, I We! a? D. EMPLOVER .3 :c?gmm if. 63:13 Cl?a EST [7 i? I [550 ADDRESS IMMEDIATE SUPER SALARY REASON FOR LEAVING 6327?? - 'Prfg? TO . - I ~23? Elmo 15.4- . . HAVE YOU EVER BEEN DISQUALIFIELI WHAT POSITION DATE DISOUALIPIED REASON FOR ANYCAREERSERVI EPOSITIONIE 9" 18. LIST SPECIAL SKILLS. TRAINING, EXPERIENCE, SUCH AS TYPING, LANGUAGE SPOKEN, ETC. INDICATE LEVEL OF ABILITY OR SPEED. igi/Ig?iy. - Ear/9? 11%;1" 270 6" Lilla _Vf?fe_c? 71. II. 6_ 'fZimum?/?z I -.19- LIST 3 RESPONSIBLE ADULTS WHO KNOW YOU WELL ENOUGH TO GIVE INFORMATION CONCERNING YOU. .. CA6. 27) ADDRESS (NE. NAME, REFERENCES ADDITIONAL REMARKS . c9 a #5 . f5? ?exams ?ne-E OTHER - SPECIFY 2. DATE Hwy? PERSONAL HI ORY QUESTIONNAIRE 1. POSITION APPLIED FOR EXAMINATION CHICAGO POLICE DEPARTMENT DPOLICE OFFICER NO- .3. NAME {LiA?L?Fmsr? M.I.J appl.] s. 5. ?14552 I?xogir?tf? 6: a. SOCIAL. SECURITY IAPF. [ea-2733;? 27 [99' #5 INSTRUCTIONS {my IT IS IMPORTANT TO READ THESE INSTRUCTIONS CAREFULLY BEFORE COMPLETING THIS QUESTIONNAIRE. in all your answers. All anSWers that you give in this application are subject to I You must be complete and truthful verification. Any failure to report completely or any untruthfui information will be considered strictly confidential and will noI In this questionnaire, a number of items ask for simple However, if you wish to explain your answers, use the continua number of the item. Use this section in the same manner. if you Do not leave any question blank. if a question does not a Your answers must be legible. RIGHT TO .If the Chicago Police Department finds you to be "not qI Personnel. After the Department of Personnel receives the finding ti cw, send to you by mail a form t?h?a-t?asks whether you desire a hear a the form back to the Chicago Department of Personnel. If you: hearing will be held and the Chicago Police Department recommendation are "not qualified" will be accepted by the Department of Personnel. ,2 If you desire a hearing, you may be represented by counsel at such hearing. Any hearing before the Department will be conducted in accordance with the RuT?s of the Department of Personnel. understand-that all of the appeal procedures are available to all candidates and thal?additional opportunities will be made available to provide clarification of the items on the questionnaire. I haVe read and I understand all of the above instructions applying to this (police officer) preinterview questionnaire. {If .- MK 9. SIGNATURE DATE 1 (Rev. 10/85) 42 . EMPLOYMENT: PRESENT OR MOST RECENT JOB FIRST. LIST IN PROPER TIME SEQUENCE ALL FULL TIME. TEMPORARY AND PART-TIME JOBS YOU HAVE HELD. PUT YOUR 1. NAME PHONE NO. 340-39M MO YR TO MO YR 4hr?? 01(1ng Equitfu?j?lg Ma ADDRESS 9165-0 5-- Edfi?rnfn (CITY. STATE. ZIP CODE) 6080c? TYPE BUSINESS (61 Nr?hcwerheu?c OUR [10.15: . jam - YOUR BUT 55 RE ?863 am) .wum/zu: ec rm) REASON F.0R LEAVING 2. NAME 0P ?rycig?pg?r .. PHONE NO. 739/4500 0 YR TO MO YR 4M 2821;? 2007 ADDRESS /00 w. (CITY, STATE. ZIP CODE) C?w_ 0C0 I TYPE BUSINESS ?m'a?wt?we?f YOUR EXPLAIN WHAT YOUR DUTIES - RE I . 4. ae C??rfg?l?t?-?g?d ld/LJ 3. NAME REASON F0 LEAVING rI-eel?rawmg {an me- 22C of (?ow Palm-MP.? ?uen?fc, few/E53? PHONE NO. MO YR TO MO YR ADDRESS /06 CO, yaNapo?dl; (CITY. STATE. ZIP CODE) $904229. ?oecc TYPE BUSINESS In: ?h?reepaci?" YOUR TITLEIPOSITION euro ?:9me go ?new EXPLAIN WHAT YOUR DUTIES WERE. 3576 :fea cu) I EMPLO YE R's NAME REASON F0 LEAVING inf -0350 .726. bop-f. ofcomgcn?om Lamb/es? PHONE NO. 5ch?050 :77 ADD REES 63.0. Bog /o?2.2 (CITY, STATE, ZIP CODE) Sf-Ciwfesjf?. do we 2 Draw? YOU ISDC 70.0 w?i?k?/LZF? EXPLAIN WHAT YOUR DUTIES WERE SILL eoy?tc?mae??'on Ego-1404; 5. EMPLOYE NAME IM EDIA E5 REASON FOR LEAVING ?anag? 155 m. 12L JFVC PHONE NO. la 6 05'0 MO MO YR I2 Mai 16; 579/ ADDRESS Rd? 37C (CITY. STATE, ZIP CODE) 37:. 0mm; 31, oncc PE BUSINESS aw YOUR. (yd WM. ?mum-az? EXPLAIN WHAT YQUR DUTIES WERE zbuaatm'v JEE (Add IMMEDIATE su?Enwson REASON FOR LEAVING Axial-EM ?an? 6. NAME PHONE N0ADDRESS (CITY, STATE. ZIP CODEI TYPE BUSI E55 YOUR EXPLAIN WHAT YOUR DUTIES WERE IMMEDIATE SUPERVISOR REASON FOR LEAVING 7. NAME PHONE N0. M0 YR T0 MO YR ADDRESS i (CITY, STATE. ZIP TYPE BUSINESS YOUR ION EXPLAIN WHAT YOUR DUTIES WERE IMMEDIATE SUPERVISOR REASON FO LEAVING 8. NAME PHONE N0. M0 YR TO MO YR ADDRESS (CITY. STATE. ZIP CODE) TYPE BUSINESS YOUR EXPLAIN WHAT YOUR DUTIES WERE IMMEDIATE SUPERVISOR REASON FOR LEAVING 9. NAME N0. M0 YR TD MO YR ADDRESS (CITY. STATE. ZIP TYPE BUSINESS YOUR TITLEIPOSITION EXPLAIN- WHAT YOUR DUTIES WERE IMMEDIATE SUPERVISOR REASON FOR LEAVING 43.HAVE YOU EVER BEEN ACCEPTED QR REJECTED FOR A CIVILSERVICE IF EXPLAIN Emma ND 45. HAVE YOQRVER BEEN 0R ASKED TO RESIGN FOR INSUEORDINATION OR IF YES. EXPL-AIN 41-4. MAY WE CONTACT ENT mm F, CPD-62.152 ?Hh' POLICE DEPARTHENT I ?y?k jgg?r? A: 517/502 ISTRUCTIDHS: all accurately and Cumpietely. WE will be disquali?ed for any false statements. RINT all information In hiack ink additional in ?13 Remarks section. - NAME (LA T- FIRST 61/ RUNIE ADDRESS (STREET Alf/i LIST ANY OTHER NAMES OR ALIASES VE SOCIAL SECURITY ND. 4. HOME TELEPHONE uu nu: um": "Emu" 5501/5137?, jug/3? REQUEST NO. SOURCE DATE INEERPRINTED PRINTS BUSINESS TELEPHONE ND. Wf'ig?j? 6. D0 TDD HIWE A WILID IF YES. GIVE NUMBER APPOINTMENT DATE EMPL 61:31 YES NO UNIT ASSIGNMENT Cl 1? 3. DID YDELIS SERIIE IN 111:1lel U.S- ARMED IF YES. BRANCH OF SERVICE 9- DATE ENTERED AHHED SERVICE E1 26:3? 10. DATE DISCHARGED FROM ACTIVE DUTY 11. RANK AT DISCHARGE 12. TYPE OF DISCHARGE 13. ARE YDUA HIGH SCHOOL .11: No. DID YOU GETA IF YES. GIVE DATE RECEIVED -lF NEITHER. Raw RANT TEARS DF HIGH SCHOOL DID YOU YES No 3 El YES I: No DATE- I DEGREE DR NAME OF SCI-IUDI. cm STATE Ema ma?a ?ggwm?a MAJUR COURSE I . . I 5? l/ DIP r5?? ATFEHDEE) I - I Liam I and . I JUNIOR I come I I CDLLEGE I NM i 02 i ?94 IUNWERSIWU 07 mama/2m 91? I RIDER I BUSINESS I 03557 IF YOU NEED ADDITIONAL SPACE. INDICATE THE YOU ARE ANSWERING. THEN YOUR ANSWER BELOW. CPD - 52.2% (REV. 9f95) CONTINUE ON REVERSE APPLICANT - PAS APPLICANTSWE 0M5, ?ew! (6/54; 14. LIST PRESENT PREVIOUS EMPLOYMENT IN REVERSE CHRONOLOGICAL ORDER FOR THE PAST 5 YEARS. START WITH THE PRESENT. PO FROM T0 - EMPLOYMENT BACKGROUND SKILLS A @740 MS AM. 22 Wm MW ADDRESS I . I I SALARY FORLEAVINO [21/ PU FM TO Norm SIION mom. MA I . . . iv): ?nial" 72/7? D??aq :54;sz ADDRESS IM DIATE PER SOR . $707) M1 24% Whaw?ra? Me? C. PD IION FROMP ONE. ITD- OHS. I?zr 731/6/ ?ff 1 6319 AD HESS REASON FUR LEADING AI. 54M (M Ida-1L4- D. IAPLD POSITION Tum. TO- AIMS vL/gzwezvl?? Uta a?g ADDRESS INIIAE REASONIIOR LEAVING Io/szs C, (DOWNL n- . .A PLO 905?? FROM- .T ?a g2 Ea/ ?ak lMM/??ggmm? 0% 949 :95, ADO SALAD FUR LEAVING Id Mir-I?Z?re? m?/?fwa?zlivmsb?if? F. EMPLOYER PRDNI- MOJYH. .I TO- MOM-T. I ADDRESS IMMEDIATE SOPERVEOR SALARY Base" Fun LEADINE 15. .IFYES. GIVE OEPAZIENI NAME FROM To YES 0 "0 I d?/m 1s. yousven BEEN msuquFIEO . WHAT DATE DISOUAUREO REASON FURANYCAREER VICE I Er YES 0 I 17. COMPUTER SKILLS: CHECK THE BOXES THAT APPLY: EIIPEIIT FAIR NONE EXPERT FAIR NONE WORDPERFECT )9 a El OTHER (PLEASE SPECIFY) a I: OUATTRO-PRO I: )iO PARADOX a El Fa th?7? It. LOTUS1-2WINDOWS I: 13. ADOTTIONAL SKILLS AND 554/009" ESHURTHAND WPM: EDICTAFHUHE INPNI: All/(4L OTHER: REFERENCES 19. LIST 3 ADULTS WHO KNOW YOU WEL ENOUGH TO GIVE INFORMATION CONCERNING YCIU AND YOUR EMPLOYMENT HISTORY. ADDRESS INO..STREET 594M 3? er] (PIKE. PERSONAL HISTORY 1. POSITION APPLIED FOR: EXAM h? 2_ DATE OF BIRTH BACKGROUND INVESTTGATION (DAY-MONTH-YEAR) CHICAGO POLICE DEPARTMENT '3 I OPS I s. N0 705138?? 157550 7. PAGER PHONE NO. 8. CELL PHONE NO (I- i 3. NAME (LAST - FIRST- MIDDLE INITIAL) 4. MAIDEN NAME (IF APPL.) 5- HOME PHONE ?0 9. (STREET NUMBER 8 NAME - APARTMENT NUMBER - CITY 8: STATE - ZIP CODE - COUNTY) 10. SOCIAL SECURITY N0. INSTRUCTIONS PRINT OR TYPE ALL INFORMATION IT IS IMPORTANT TO READ THESE INSTRUCTIONS CAREFULLY AND TO SIGN THE ZAT 0 OR LE SE ON INF CONTAINED ON THE LAST PAGE OF THIS QUESTIONNAIRE. You must be complete and truthful in all your answers. All answers that you give in this application are subject to verification. Any failure to report completely or any untruthful answers will subject you to rejection as a candidate. You are not required to disclose your HIV status in response to any question herein. In this questionnaire, a number of items ask for simple "yes" and "no" answers and do not require any explanation. However, if you wish to explain your answers. use the CONTINUATION SECTION on page 9 of this questionnaire. Before each answer or explanation, write the item number for reference. Do not leave any question blank. If a question does not apply to you, write (Abbreviation for "Not Applicable"). Your answers must be legible. Do not disclose any medical or conditions in response to any question herein. DISCLAIMER I understand that the processing of this Personal History Questionnaire is not a guarantee of employment or hire as a Probationary Police Officer or the position applied for. I further understand that consideration for employment is dependent upon my successful completion of all steps of the process for this position and upon the availability of a budgeted position for Probationary Police Officer or the position applied for. have read and understand all of the instructions pertaining to this Personal History Questionnaire and the content of the above disclaimer. 11. SIGNATURE (APPLICANT) 12. DATE (DAY - MONTH - YEAR) 07/03/05 52 (REV arcs) PAGE1 - 44. EMPLOYMENT: LIST IN PROPER TIME SEQUENCE ALL FULL-TI PRESENT OR MOST RECENT JOB FIRST. EXP I I ME. PART-TIME AND TEMPORARY JOBS YOU HAVE HELD. LIST YOUR LAIN ALL GAPS IN EMPLOYMENT IN THE CONTINUATION SECTION. 1. NAME (MOST RECENT) WWI PHONE NUMBER (705? 2350 MO YR TO M0 YR (I3 IOLII ADDRESS R250 Jam ?rst. (CITY. STATE, ZIP CODE) IL @525 TYPE OF BUSIN ESS 2244;! YOUR TITLEIPOSITION EXPLAIN WHAT YOUR DUTIES 2. MM 0206 EDIATE SURERVISOR REASON LEAVING N74 PHONE NUMBER (77535575790 MO YR To MO YR .001an ADDRESS W0 5. 46*? 57% (CITY, STATE, ZIP CODE) (WI. TIL way/7 TYPE OF BUSIN ESS DIRK YOUR TITLEIPOSITION 7?8 I Ier EXPLAIN WHAT YOUR DUTIES WERE massed MWSEICHIJ n5 NAME l/ IMMED TE SUPERVISOR REASON FOR LEAVING . PHONE NUMBER I775 1757 ADDRESS 1? 57M 5. 41/6, (CITY, STATE, ZIP CODE) CWO. 11L 577127 TYPE OF BUSINESS mas/V 5th YOUR TLEIPOSITION EXPLAIN WHAT YOUR DUTIES WERE maria 4. IMMEDI SUPERVISOR I. ASON LEAVING WMIC/?fgahm ?at PHONE NUMBER ADDRESS (CITY. STATE. ZIP CODE) TYPE OF BUSINESS YOUR EXPLAIN WHAT YOUR DUTIES WERE IMM EDIATE SUPERVISOR REASON FOR LEAVING 5. NAME PHONE NUMBER ADDRESS (CITY, STATE. ZIP CODE) TYPE OF BUSINESS YOUR EXPLAIN WHAT YOUR DUTIES WERE IMMEDIATE SUPERVISOR REASON FOR LEAVING 6. NAME PHONE NUMBER ADDRESS (CITY, STATE. ZIP CODE) TYPE OF BUSINESS YOUR EXPLAIN WHAT YOUR DUTIES WERE IMMEDIATE SUPERVISOR REASON FOR LEAVING 7. NAME PHONE NUMBER I I I I I ADDRESS (CITY, STATE. ZIP CODE) TYPE OF BUSINESS YOUR EXPLAIN WHAT YOUR DUTIES WERE IMMEDIATE SUPERVISOR REASON FOR LEAVING PAGE 5 BHICAEIJ POLICE DEPARTIHEIIT I I ADO lacy/,5? INSTRUCTIONS: Mswer OI I uestinns ancuralely and completely. You will he disqyali'?ed for any false slatemans. PRINT all information in hm: ink Llstadd'rtional in the Ramada I. Qllilnleq HOME CODE) 2. SOCIAL SECURITY H0. 4. TELEPHONE NU. EEODEETIIO. 9/133500/ 06 SOURCE CSIEC DATE RHOERPRIHTED AV MM ?70 PRINTS at.) EMF LIST ARV DRIER NAMES Ou HAVE 5. BUSINESS TELEPHONE HO. NONE T313- 36g.3qq3 ARROI EHT TE 7. DO YOU HAVEAVALID HFYES GLVE NUMBER ?2,605" 670 3. gr} YEESSERVEKACREE DUTYINTHE us. ARMED IF YES. BRANCH OF SERVICE 9. DATE ENTERED AHMED SERVICE 10. DATE DISCHARGEO FROIIACITVE DUTY 11. RANK AT DISCHARGE 12. TYPE OF 13. ARE YOU A HIGH SCHOOL - VEs. GIVE DATE RECEIVED . IF HEITHER. HEW MW YEARS OF HIGH SCHOOL DID YOU can 5 UYES BNO DATE: 1 NAME OF SCHOOL cm 8. STATE FROM TO DEGREE a? MOJYR. MONK. VEs N0 m? WM 2 ATTEHDED (1 en {14! M. 5? - 2 JUNIOR COLLEGE pfq?ge 511mb O/I?fe a . COLLEGE NOT IL Um Whirl-3L 3/035 5/43 [3 I4- Jul UNIVERSITY I TRADEOR BUSINESS I SCHOOL 1 0:55" IF YOU HERO ADDITIONAL SPACE. IHDICATE THE auEsnOH You ARE THEN YOUR AuswER BELOW. ?3 .SU 131.? bum) I egg from 3/5! 3 H) H193 N5 I (Quid/w 74? Sag ?ora Squ 5 2 CPD 522.00 (REV. 9f95) CONTINUE 0N REVERSE APPUCANY OUESTIONNAIRE- PAGE: tog/km??r 14. LIST PRESENT 8: PREVIOUS EMPLOYMENT IN REVERSE CHRONOLOGICAL ORDER FOR THE PAST 5 YEARS. WITH TIE PRESENT. A IMOSY RECE PCSITIGH - MOIYR. MOIYR. 006 WIN ?5 Hm 614m: sq?er. )lor 4.3 RESORT ADDRESS I I EDIATE VP VISOR REASON FOR LEAVING QCED 5- QIIQINIR AWE CORNWALL B. EMPLOYER FROM- Marni, Tu- Harm. I ADDRESS IMMEDIAIE SUPERVISOR SALARY REASON FOR LEAVING c. EMPLOYER POSITION EROM- MOIYR. I TO- MOJYR. I I ADDRESS IMMEDIATE SUPERVISOR SALARY REASON FOR LEAVING 5 D. EMPLOYER PosmON FROM- MOIYR. 1 EL MOIYR. 2 I I ADDRESS SUPERVISOR SALARY REASON FOR LEAVING In E. EMPLOYER 903mm FROM- MOJYR. I TO- MOJYR. 0 I ADDRESS IMMEDIATE SUPERVISOR SALARY REASON EUR LEAVING F. EMPLOYER POSITION FROM- MOJYR. .I TO- MOJYR. I ADDRESS IMMEDIATE SUPERVISOR SALARY REASON FOR LEAVINE 15. HAVE YOU EVER BEEN EMPLOYED . IF YES GIVE DEPARTMENT NAME PROM RY THE CITY 16. HAVE YOUEVERBEEN OISOUALIRED . DATE DISOUALIREO REASON PORANY RVIOE [3 YES NO I 17. COMPUTER Sims: CHECKTHE BOXES THAT APPLY: an PAIR DIPERY PAIR IIDNE INORDPEREGCT a CI OTHER (PLEASE SPECIFY) i El mum" '3 ?5 ?IRan Paine WINDOWS I: a In IE. AND ABILITIES: I I I I TYPING VYPM: ?10 v1." 14 WPM: YIPM: IDTHER: 19. LIST SAOULTS WHO KNOW YOU INELL ENOUGH TO GIVE INFORMATION CONCERNING YOU AND YOUR EMPLOYMENT HISTORY. 4 ADDRESS INO..STREET 8. OCCUPATION a . "at: 5?3 [will 792% .23: .3 0 Ice wager qu Gl?rfiemeni Professional Objective Education Professional Experience Other Experience Special Qualifications Bruce A. Dean A position with an educational institution, a business, or a social service agency which will utilize my communications, management, research skills, knowledge and experience. B. S., 1982, Manchester College, North Manchester, IN. Majors: Economics and History. Indiana Teacher Certi?cation, 1983. Senior Center Coordinator, Polish Welfare Association, Chicago, September WES-present. Responsible for programming and administration of senior citizens? services for Chicago's large Polish- speaking community. Cooperated with other ethnic agencies. Advised members of the Polish-speaking community to help their adjustment to life in the USA. Teacher of English as a second language, Chicago, IL., 1989? present. English teacher and translator, Polish Ministry of Agriculture, Warsaw, Poland, March 1984-May 1988. Responsible for developing and teaching English as a second language programs at schools and scienti?c institutes within the Ministry. Acted as a resource person and translator for tourist and business groups in Poland, including the World Bank. Refugee services worker, Church World Services, New Windsor, Maryland, September 1983-March 1984. Responsible for orientation, care and assistance of refugees from Southeast Asia and Eastern Europe. Experienced in meeting and Speaking on a wide variety of topics to different groups of people. Experienced in writing, translating, and editing reports and correspondence. Familiar with typical of?ce functions and computer capabilities. Substitute teacher, Elkhart Community Schools, Elkhart, IN. Extensive Eur0pean travel. Talent in dealing with people in both public and individual situations. Aware of and sensitive to cultural differences. Fluent in Polish language. Experienced in interviewing. Holman roucE - I INSTRUCTI ?gs-war all mumay and completely. You will be diSquaIf?ed for any false stalnmarrs. all informtron in black ink additional information in the Ila-malts Emotion. I 5-H Immawour. c?ps oaa/ 0c) 3. (Seed mm Jeanne A WSE HOME ADDRESS (STREET ND..NAME.CITY.ZIP IUATE FINGEFIPRINTED MW 690 SEWEDIREWEWED M?w Jo ?at 2. SOCIAL in. 5. NAMES on AIJASES YOU HAVE USED 5. BUSINESS TELEPHONE no252 APPOINTMENT DATE 7. Do YOU HAVE A VALID onwEn' Ln: IF 6 NUMBER 570 DATE HITERED ARMED SERVICE g; 8. gm I: IF YES. DRAEDHDESEMCE, 10. DATE DISCHARGED mom ACTIVE DUTY 11. IIANKATDISCHARGE 12. TYPEOFDISCHARGE 13. AREYOUAHIGH scHooL DATERECEIVED magg?omnvrowcmDATE: I NAME oEscHooL ?fmm?o LASTHIGH HIGH Sm?lom. I . ?g??lm 3200 N. szlov CHGO, 1L looms (engage? i 5 lawman 01460 H. GM 3 . ICMEGE ColombtA Co ?(2cm CHQOI IL V365 I I - IUNWERSITY CO) /0]q on I BUSINESS . SCHOOL 0:50? IF YOU NEED THE DUESDDN YOU ARE ANSAEAINS. CONTINUE voun ANSWER now. 4/ W4 07M) 4w? K5300 ?Qua, KAOSCM. @70 JJfJ/ado CPD - 52.200 985) CONTINUE 0N REVERSE EMPLOYMENT BACKGROUND APPucm DDEsnongulnE - ma. 4 NAME 14. LIST PRESENT PREVIOUS EMPLOYMENT IN REVERSE CHRONOLOGICN. ORDER FOR THE PAST 5 YEARS. START WITH THE PRESENT. FROM - MUM. I TO - DJYR. FDSITIDD .. a ASFETMTELFOEM 1 waw DRESS - IMMEDIRTE SUPERVISOR REASON FOR I050 5- Hueon *?lblb WED, ft. FROM- Hams. - mm; am PECORLIS /owne.2 /q z; IMMEDIATE SUPERVISOR lg?gmm ?gimme MADDETJEE HE 5730 D. PM: CHeo, n. SW WSWIUN Eng/y m?g?s?p VJ (HGD Rolling/:3? E. waging POWWN - 1? - Faclgq/ ADDRESSEOZLQ N. CHEDJL P05111031 F. EMPLOYER AIM ADDRESS REASD FDRLEMIHG l? wok W, 15. HAVE YGUEVERBEENE PLDYED . IFYES. GIVE DEPARTMENT DAME FROM TD I BY CITY SKILLS TEE El "0 I I. 15. HAVE YGUEUEH aemmsuumnso .IFYES.WHAT DATE DISOUAUFIED REASON mamma?sfmce Pnsmou? EL YES no . 17. com PUTER anus: BOXES THAT APPLY: wan run ?one arm ma me WORDPERFECT PM OTHER (PLEASE Slim OUATTRO-PRO PARADOX Loms1-2-3 22:) El DOS wmoows )zf a 18. ADDITIONAL SKILLS AND ABILITIES: mm mm; 50? [00 ESHORTHAND wm: EDICTAPHOHE wm; ECRTIIHPUT mgr: omen: Muima Lav'mwmaxvmlim SW (mi mIW-uw, - J. WNW 01C {aim 1 REFERENCES 19. LIST 3M1ULT5 WHO KNOW YUU WELL ENUUGH TO GIVE CUNCEHNING YOU AND YOUR EHPLUTMENT HISTDFIY. 4 NAME ADDRESS (N0..STREEI CITY) HWW M1042 i- Lw audm ANGELA L. JACKSON EMPLOYMENT 1997 - present CITY or CHICA Go - DEPARTMENT or LA Chicago, Illinois Municipal Prosecutions Division Paralegal ii i 998?Present) Assist attorneys with ety?orcing the City of Chicago?s Drug and Gang House Ordinance by drafting complaints, notices of violation, resolution agreements, consent decrees and general court orders; assist attorneys in court on high profile cases; interview police and CAPS. personnel, inspectors, investigators, and defendants for trials or resolutions; investigate defendants criminal and civil backgrounds; organize and gather documents from various City departments for trial; respond to discovery requests; subpoena documents; conduct legal research; accompany attorneys on ?eld inspections; maintain all databases by inputting new cases, monitoring the status of all cases, updating court schedules, and processing all ?nes imposed against defendants; generate reports for the month ly .Mayor 's meeting; and interact with other City of Chicago Departments and Governmental Agencies, Aldermen, Chicago Police Personnel and Community Organizations. Paralegal 1' (MW-1998) Assisted attorneys in Circuit Court and Administrative Hearings by dra?ing orders and routine motions; organized cases for trial; prepared weekly case summaries for court; digested trial transcripts for appeals; organized and distributed new cases to attorneys; dra?ed correspondence; obtained property information by conducting skip tracing and real info searches, retrieving tax, water, and real estate documents, and requesting information from various ?nancial institutions; and ?led documents in Circuit Court and Administrative Hearings. 19.96 - 1997 IN TERNA IONAL BUSINESS MACHINES (1311!) Oak Brook, Illinois Customer Support Representative Researched case histories and contracts to determine status of warranties; prepared status reports for contract specialist; reviewed warranties; added and deleted machines from IBM inventory; updated billing invoices; and was responsible for total customer satisfaction. 1.995 - I996 TEMPLETON ASSOCIATES Chicago, tllinois Legal Assistant - Assigned to Amoco Law Department Reviewed privileged and confidential material and supervised other employees in reviewing documents in preparation for trial; and maintained documents as a case assistant by updating the database. 1993 - 1994- PETERSON ROSS LA OFFICE Chicago, Illinois O??ice Assistant A ctively engaged in tri a! preparation l) reviewing docum en is for attorneys, and creating blo wbacks on micro?lm; updated correspondence and plead ings for environmental insurance coverage cases; retrieved cases to be used by attorneys in various motions; reviewed medical reports; and indexed documents to be used in court proceedings. ED CA TION 995 Roosevelt University i 99.? Bradley University Paralegal Certificate itachelor of A ABA - .-tpprovrti Leg-ti Assistant Program Major: English Sociologt Chicago, lilittois Peoria. illinois COMPUTER SKILLS Knowledge of Core! li?ot?r?ll?ec?rct 8.0. Miczrroso? Excel. Microsoft Word, Quatro Pro, Paradox. Westitmt, Ami Pro. Concordance, image, Lotus Notes, 0/5 200, and Qd?cA. PERSONAL HISTORY 1. POSITION APPLIED FOR: EXA: 2. DATE OF BIRTH DAY-MONTH-YEAR BACKGROUND INVESTIGATION El POLICE OFFICER I CHICAGO POLICE DEPARTMENT MOTHER (SPECIFY) 1AM . I 25. Mar?hlq}8 3. NAME (LAST - FIRST- MIDDLE INITIAL) 4. MAIDEN NAME (IF APPL.) 5- HOME PHONE NIUO I5. A 7. PAGER PHONE no. . CELL PHONE no II 9. HOME ADDRESS (STREET NUMBER NAME - APARTMENT NUMBER - CITY 8. STATE - ZIP CODE - COUNTY) 10. SOCIAL SECURITY INSTRUCTIONS PRINT OR TYPE ALL INFORMATION IT IS IMPORTANT TO READ THESE INSTRUCTIONS CAREFULLY AND TO SIGN THE HORIZA IO F0 SE PE I F0 TION CONTAINED ON THE LAST PAGE OF THIS QUESTIONNAIRE. You must be complete and truthful in all your answers. All answers that you give in this application are subject to verification. Any failure to report completely or any untruthful answers will subject you to rejection as a candidate. You are not required to disclose your HIV status in response to any question herein. In this questionnaire, a number of items ask for simple "yes" and "no" answers and do not require any explanation. However, if you wish to explain your answers. use the CONTINUATION SECTION on page 9 of this questionnaire. Before each answer or explanation, Write the item number for reference. Do not leave any question blank. If a question does not apply to you. write (Abbreviation for "Not Applicable"). Your answers must be legible. Do not disclose any medical or conditions in response to any question herein. DISCLAIMER I understand that the processing of this Personal History Questionnaire is not a guarantee of employment or hire as a Probationary Police Officer or the position applied for. I further understand that consideration for employment is dependent upon my successful compietionof all steps of the process for this position and upon the availability of a budgeted position for Probationary Police Officer or the position applied for. have read and understand all of the instructions pertaining to this Personal History Questionnaire and the content of the above disclaimer. 12. DATE (DAY - MONTH - YEAR) I 2? Wem?zr?/ cpn-s2.152 (REV 3:02) PAGEI NAME PHONE Late CIMID I I NA DIME ADDRESS (CITY. STATE. ZIP CODE) TYPE OF BUSINESS YOUR WARM. Outta?? WWI UM Ex REASON FOR LEAVING I TYOUR TIES WERE gar and ROI 0 NAME WYMR In SokooI MITWRS PHONE NUMBER I I MOYRTOMOYR I I I ADDRESS (CITY, STATE. ZIP CODE) TYPE OF BUSINESS YOUR POSITION EXPLAIN WHAT YOUR DUTIES WERE IMMEDIATE SUPERVISOR REASON FOR LEAVING 10. NAME PHONE NUMBER ADDRESS (CITY. STATE. ZIP CODE) TYPE OF YOUR TITLEIPOSITION EXPLAIN WHAT YOUR DUTIES WERE IMMEDIATE SUPERVISOR REASON FOR LEAVING 45. HAVE YOU EVER BEEN ACCEPTED OR REJECTED FOR A CIVIL OR GOVERNMENTAL DYES IF EXPLAIN: 46. HAVE YOU EVER BEEN DISCHARGED OR ASKED TO RESIGN FROM ANY IF YES, EYES NNO 47. HAVE YOU EVER BEEN DISCHARGED FROM ANY EMPLOYMENT SPECIFICALLY FOR INSUBORDINATION, ABSENTEEISM 0R IF YES. EXPLAIN: 4B. HAVE YOU EVER BEEN DISCHARGED FROM ANY EMPLOYMENT FOR THEFT. INCLUDING AN OVER-RING OR UNDER-RING WHILE EMPLOYED AS A IF YES. EXPLAIN: EIYES 49. HAVE YOU EVER FAILED TO COMPLETE THE PROBATIONARY PERIOD FOR ANY IF YES. EXPLAIN: DYES MIND 50. HAVE You EVER RECEIVED ANY REPRIMANDS, WARNINGS OR BEEN SUSPENDED FROM ANY EIYES mm H: YES. EXPLAIN: . 51. HAVE YOU EVER RECEIVED UNSATISFACTORY OR BELOW AVERAGE PERFORMANCE DYES ?uo IF YES. EXPLAIN: 52. HAVE You EVER BEEN INELIGIBLE FOR RE-EMPLOYMENT AT ANY IF YES, EXPLAIN: DYESMNO PAGE 6 APPLICANT QUESTIONNAIRE CHICAGO POLICE DEPARTMENT I-?Ubl IIUN AngltU Im :1 ATE DO NOT WRITE IN THIS SECTION ll POSITION 04.553 msmucnous- Answer all questions accurater and mmplelaiy. You will be disquali?ed for any false StalemEIIts. r? PRINT an information in I) lack ink. List additional in the Ramada section. HEDUEST no. {00? F: can SOURCE ling: NAME (LAST- DIM l2, Jr .90 ADDRESS (STREET CODE) 2. SOCIAL N0. DATE PRINTS EMPLOYEE HO. LIST ANY OTHER HADES 0R ALIASEG YOU HAVE USED G. BUSINESS TELEPHONE M4 @123) 3% O. T. 00 YOU HAVE A VALID IF VEG DIVE HDMHEA I t- 0 I UNIT OF YES El NO Ir s. DID YOU SERVE ACTIVE DUTYIN THE IF YES. BRANCH OF SERVICE 9- DATE EN RED ARMED SERVICE I: YES I: no it; 10. DATE ACTIVE DUTY 11. RANK AT 12. TYPE DE NEW ?u 4 13. AREYOUA HIGH SCHOOL . IFNO. DID YOU IF YES. GIVE DATE RECEIVED . IF NEITHER. YEAHG HIGH SCHOOL DID YOU p. YES NO I 13 YES DATE: 5? I DEGREE 0? NAME OF SCHOOL CITY STATE YES "0 wan mugs-,5 LAST HIGH - - .. . SCHOOL [4 I a I I ATTENDED LI I I Ara/J 9 I 5 ELLE-33.4. UNIVERSITY . . A 0/g T. 17/ WI 5 A?a?y? 4/ JD. 1' I /77? Mmf/ A, TRADE 1' I I SCHOOL I 0%57 IF YOU IIEED luochTE THE DUEsnoIl YOU ARE ANSWERING. THEN YDUH AusuEH BELDIIV. 8 4 2 2 CPO (REV. CONTINUE 0N REVERSE APPLICIHT OUESTIOHHIHE - PAS: 14. LIST PRESENT PREVIOUS EMPLOYMENT IN REVERE CHROIIOLOGICAL ORDER FOR THE PAST 5 YEARS. ST ART WITH THE PRESENT. A. ENPLOYERINOST RECENT) EROIH- Im- Com??w? 51919 ?/i??krs?f 936%?? ADDRESS I REASON Ff/R?tiwm W- (7954?" 62s,? mm, ?e B. EAIPLOYER I POSITION mun- Rum. I TO- MORE. I I ADDRESS INNEDIATE SUPERVISOR SALARY REASON FOR LEAVING c. ENPLOYER POSITION FROIA- HOJYR MOJYR I I ADDRESS IMMEDIATE SUPERVISOR SALARY REASON FOR LEAVING '5 D. EMPLOYER FROM- I TO NOJYR 8 I I ADDRESS INNEDIAIE SUPERVISOR SALARY A. EMPLOYER 9051710" FRou- NOJYR. . TO- NOJYR. 0 ADDRESS SUPERVISOR SALARY REASON FOR LEAVING . F. EMPLOYER FROII- .. TO- IIOJYR. ADDRESS SALARY REASON FOR LEAVING 15. HAVEYOUEVERBEEN ENPLOYED DEPARTNENTHANE FROH T0 BYTHE CIIY 15. HAVE YOU EVER DEER DISOOALIRED . IF YES INHAT DATE DISOUAURED REASON FOR ANY CAREER CE I YES NO . 17. COMPUTER SKILLS CHEGK 11E BOXES THAT APPLY: FAIR NONE EXEHT PAIR IIDIIE :1 )1 El OTHER (PLEASE SPECIFY) OUATIRO-PRO I: u. PARADOX E1 :1 SK LOTUS 1-2-3 :1 008 El 3 WINDOWS CI :1 2 I?ll 18. SAME AND ABILITIES: I I TYPINO IVPIA: INPAI: WPM: WPH: IDTHER: 19. LIST 3 ADULTS mow YOU WELL ENOUGH TO GIVE INFORMATION CONCERNING YOU AND YOUR EMPLOYMENT HISIORY. ER NAME ADDRESS INOSTREEI 8. CITY) OCCUPATION . 5 MM ?YQ/f?mf ?g?c?f #wm myde mum m?u?IL??eSheet Gm inc-5' some PERSONNEL DATA FORM FOR OFFICE USE: PLEASE PRINT - PRESS FIRMLY SAIE 12: Fits: a} w? 1 I 3? 9?26.: -- Jun-?5 Lm..-aammnam 3mg: mama-WELmEEa M?No?ormaax we .GradeSchool Duo am mm YEARS COMPLEFED: Graduated DEGREE: LJAA Emras Dru-.0 Dom EYES No MILITARY RECORD: Were you in the Armed Service? From: Month Year 1 0: Month Year I N03 Present Status I 0mm cams magnum: Year #wmm lw??m a Ceru?cae Received Sem. HI: Hrs. HISTORY 1. POSITION APPLIED FOR: EXAM 2. DATE BACKGROUND INVESTIGATION CHICAGO POLICE EIPOLICE OFFICER (DAY MONTH YEAR) BOTHER (SPECIFY) 0 PS (memes/imam I 052 5-5/7; quf 3. NAME (LAST - FIRST- MIDDLE INITIAL) 4. MAIDEN NAME (IF APPL.) 5. HOME PHONE 6. BUSINESS PHONE LUKHS) Tam-=5 6? Mq (gizwve-ngg 7. HOME ADDRESS (STREET NUMBER 8: NAME - APARTMENT NUMBER - CITY 8: STATE - ZIP CODE - COUNTY) . SOCIAL SECURITY INSTRUCTIONS PRINT OR TYPE ALL INFORMATION IT IS IMPORTANT TO READ THESE INSTRUCTIONS CAREFULLY AND TO SIGN THE AUTHORIZATION FQR RELEASE PERSONAL INFORMATION CONTAINED ON THE BACK COVER OF THIS QUESTIONNAIRE. You must be complete and truthful in all your answers. All answers that you give in this application are subject to verification. Any failure to report completely or any untruthful answers will subject you to rejection as a candidate. In this questionnaire, a number of items __ask for simple "yes" and "no" answers and do not require any explanation. However, if you wish to explain your answers, use the CONTINUATION SECTION on page 10 of this questionnaire. Before each answer or explanation, write the item number for reference. Do not leave any question blank If a question does not apply to you, write (Abbreviation for "Not Applicable"). Your answers must be legible. DISCLAIMER I understand that the processing of this Personal History Questionnaire is not a guarantee of employment or hire as a Probationary Police Of?cer or the position applied for. I further understand that consideration for employment is dependent upon my successful completion of all steps of the process for this position and upon the availability of a budgeted position for Probationary Police Of?cer or the position applied for. I have read and understand all of the instructions pertaining to this Personal History Questionnaire and the content of the above disclaimer. h" DATE (DAY MONTH - YEAR) 02 55/7; ?79 S. SIGNATURE APPLICAN CPD - 62.152 (REV. 0294) PAGE 1 APPLICANT w-?mw ?mum DATE DEPARTMENT ngim OPS I 23 I INSTRUCTIONS: AnSwer all questions accurately and You will he diquRiitied for any false sl?tements PRINT all information in black ink. List additional information In the Remarks section. I. NAME (LAST - FIRST 3. HOME ADDRESS CODE) 2. SOCIAL SECURITY NU. BUSINESS TELEPHONE NCI. DO YOU HAVE A VALID IF YES. GIVE NUMBER ND Shem-ml DO NOT WHITE IN THIS SEBTIDN POSITION Wig/754;? REQUEST NO. y/gf (3:363, 7/7 SOURCE 6?56 DRTEFIN RPRINTED .553 W6 77 PRINTS RECEIVEIJIHEVIEWED 9"7 EMPLO APPOINTMENT DATE Jig/Mg: ?7 UNIT OF ASSIGNMENT #5 9. DATE ENTERED ARMED SERVICE a. DID You SERVE IN THE US. ARMED IF YES. OF SERVICE El YES E4 10. DATE DISCHARGED FRDNI ACTIVE DUTY 11. RANK AT DISCHARGE 12. TYPE or DISCHARGE 13. ARE You A HIGH . YES, GIVE DATE RECEIVED . IF NEITHER. HDTV MANY YEARS OF HIGH DID You DATE: 5 FROM TO DEGREE UR NAME OF SCHOOL CITY STATE YES NO {.53.th LAST HIGH A I FILL, SCHOOL ATTENDED SAID IEC 5 JUHTDR I CDLLEGE I a I CULLEGE EFL . i I CPU ml.? a] 5 kills ICE. UNIVERSITY I I TRADEDR BUSINESS I IF You NEED ADDITIONAL SPACE. INDICATE THE DUESTIDN You ARE ANSWERING. THEN CONTINUE YDUR ANSWER In if a CPD - 62.200 (REV. CONTINUE 0N REVERSE APPLICANT QUESTIONNAIRE PAGE NAME 15- LIST PRESENT KI PREVIOUS EMPLOYMENT IN CHRONOLOGICAL ORDER FOR THE PAST 5 YEARS. START WITH THE PRESENT. RECENT) POSITION c. 1052-: ??eve?u?au K?gawu 57" I/chv I P?c?ur ADDRESS IMMEDIATE SUPERVISOR SALARY REASON FOR LEAVING S92 0 5. make? ??mm :94 6900 - a. EMPLOYER POSITION 2 dank" .. gram?; 773315? [ad/4171? E. 62 I 7 5 ADDRESS IMMEDIATE SUPERVISOR SALARY REASON FOR LEAVING To 45m?; (0210:2241? M?y?w?r?vr (57 6S0 5.. arc/kw $101090 c. EMPLOYER POSITION ADDRESS IMMEDIATE SUPERVISOR SALARY REASON FOR LEAVING i? 5 D. EMPLOYER POSITION Ill ADDRESS IMMEDIATE SUPERVISOR SALARY REASON FOR LEAVING 16. HAVE You EVER BEEN EMPLOYED IF YES. DEPARTMENT FROM TO BY THE CITY OF DYES END - 17- HAVE You EVER SEEN DISODALIFIED IF YES. WHAT POSITION DATE DISQUALIFIED REASON FOR ANY CAREER SERVICE 18. LIST SPECIAL SKILLS. TRAINING. EXPERIENCE, SUCH AS TVPING. SHORTHAND. LANGUAGE ETC. INDICATE LEVEL OF ABILITY EED. 3 ORSP ?4 (Ami/Mme (ANSWER. M4291. if ?/Rv?emf? /54-m 1905 Mam ?rm-P: ?/zzm-L 35/521745. i 1?9- LIST 3 RESPONSIBLE ADULTS WHO KNOW YOU WELL ENOUGH TO GIVE INFORMATION CONCERNING YOU. NAME ADDRESS (N0.. STREET 8. CITY) OCCUPATION a: Cay/mg M?A/?qcs? ADDITIONAL 8. NAME PHONE NUMBER art/A 4?17?: I 155.92" STATE. ZIP TYPE OF BUSINESS YOUR max, Ma? bmyam. (3v Ir?L/E?ra WI IRE-FRI: IMMEDIATE SUPERVISOR REASON FOR LEAVING ?3 I . 715m;- {J?oxv?ff ?15643 Ur} 9. NAME PHONE NUMBER MO YR TO M0 YR jMEr? :0 a.qu I, Fme I PM MES: 55 I I le/ ISEYI ADDRESS (CITY, STATEI ZIP CODE) TYPE OF BUSINESS YOUR t??thi (Fy?n?ra Suns) CW0) fool 3L EXPLAIN WHAT YOUR DUTIES WERE IMMEDIATE SUPERVISOR REASON FOR LEAVING S192 (pow ,7 Mar; My} $5,400 4, wag/K 10. NAME PHONE NUMBER ADDRESS (CITY. STATE, ZIP CODE) TYPE OF BUSINESS YOUR EXPLAIN WHAT YOUR DUTIES WERE IMMEDIATE SUPERVISOR REASON FOR LEAVING 40. HAVE YOU EVER BEEN ACCEPTED OR REJECTED FOR A CIVIL OR CAREER SE VICE KI YES END IF YES. EXPLAIN: I'm 5 far: or; rms??mmi Accra-m? 0W Fem, pow ?mfg: 41. HAVE YOU EVER BEEN DISCHARGED OR ASKED TO RESIGN FROM A CIVIL OR CAREER SERVICE POSITION OR EYES ENC ANY OTHER IF YESI EXPLAIN: 42. HAVE YOU EVER BEEN DISCHARGED FROM ANY EMPLOYMENT SPECIFICALLY FOR INSUBORDINATION. YES END ABSENTEEISM OR IF YES. EXPLAIN: 43. HAVE YOU EVER BEEN DISCHARGED FROM ANY EMPLOYMENT FOR THEFT. INCLUDING AN OVER-RING OR EYES NO UNDER-RING WHILE EMPLOYED AS A IF YES. EXPLAIN: u. HAVE You EVER FAILED TO COMPLETE THE PROBATIONARY PERIOD FOR A El YES IBNO IF YES. EXPLAIN: 45. HAVE You EVER RECEIVED ANY REPRIMANDS. WARNINGS OR BEEN SUSPENDED FROM A [3 YES ENC IF YES. EXPLAIN: 4s. HAVE YOU EVER RECEIVED UNSATISFACTORY OR BELOW AVERAGE PERFORMANCE El YES No IF YES, EXPLAIN: 41. HAVE YOU EVER BEEN INELIGIBLE FOR RE-EMPLOYMENT AT ANY El YES ENC IF YES. EXPLAIN: . CPD - 62.152 (REV. 02/94) PAGE 6 name rams hammer" 11:" INSTHUUIIM Arm: all quatim?s accuraJaly and completely. You will be disquali?ed for any false statements PRINT information In biack Ink L'at add?iunal infomlation the Romadcs section. Ivestigator I LA qu- Inn-p II-iiu. .I- nun-u "nail-HI! Posmau ?mumm- 91330U0298 SOCIAL ECUBITY NO. I. NAME FIRST 2. Lyons Kristi M. HO 4. HOMETELEPHOHE DATE ?4 lit} IPRIITES EMF 6. BUSINESS NO. 5. LIST ANY OTHER NAMES OR AIJASES YOU HAVE USED 2 2?8 3 1 37 893 @567 g? DO YOU HAVE A VALID IF YES. GIVE NUMBER UNIT OF ASSIGNMENT Acyow u.s. ARMED IF YES. BRANCH OF SERVICE 9. DATE ENTERED ARMED SERVICE 4: El E1 . 10. DATE DISCHARGED FROM ACTIVE DUTY 11. BANK AT DISCHARGE 12. TYPE OF DISCHARGE 13. ARE YOU A HIGH SCHOOL - YES. GIVE DATE RECEIVED - IF NEITHER. HOV.I MANY YEARS OF HIGH SCHOOL DID YOU YES :1 l0 CI YES N0 DATE: FROM To DEGREE 0? NAME OF SCHOOL cm 3. STATE ?0m. YES "0 MAJOR COURSE I Mo ther Theodore High School ATENDED 800 1 Belmont Avenue River Grove Illin01s 2 I a 5 JUNIOR . COLLEGE a COLLEGE Northeastern Illinois University BS 5500 North St. Louis Avenue, Chicago, Illinois 9/89 5/94 Irim. Just. R00 sevelt University Parai?ggal 430 South Michigan AVenue, Chicago, Illinois 6/94 9/94 cert icat TRADE 0R I BUSIESS I SCHOOL IF YOU IEED ADDITIONAL SPACE. INDICATE THE DUESTION YOU ARE ANSWERING. TIEII commue YOUR ANSWER mow. ?22 51? .Z ?56 73? <97? 50 4? ?g was 3.0527 9352.200 IFIEV. CONTINUE ON REVERSE APPUOANT OUESTIONNAIRE - PAGL a! APPLICANTSNAME Lyons, Kristi M. 14. LIST PRESENT 8: PREVIOUS EMPLOYMENT IN REVERSE CHRONOLOGICAL ORDER FOR THE PAST 5 YEARS. START WITH THE PRESENT. i Legal Nurse F'nn {:11 A. EMPLOYER RECENT) POSITION FRONI - I TO - _Law Office? of Tom Leahv Paralegal 10/96 Inreqenr ADDRESS REASON 77 West Washington 1900 Chgo IL still employed 8. EMPLOYER POSITION FRDH- I TO - MONO. Jeffrey M. Goldberg Associates ecords Paralegal 6/95 I 10/96 . I 35 IMMEOIA WHY REASON FOR LEAVING Clark Street #3100 Chgo 1% took new position 8. EMPLOYER POSITION MOJYR. TO- MOJYR. Susan E. Loggans Associates DOcket Clerk 10/94 I 6/95 a ADDRESS IMMEDIATE SUPERVISOR SALARY REASON FOR LEAVING 3 200 West Madison #2800 Chicago IL took new positign o. FROM - I TO - LEONE. Plaza Research Recall?iter/Night Supervisor 8/90 L- 10/9qu ADDRESS IMMEDIATE SUPERVISOR MARY REASON Fan Lemma 5450 North Cumberland, Chicago IL took jogit inn in fielc E. EMPLOYER - DJYR. I - OJYR. Chicago Police Department 014 Intern I ADDRESS IMMEDIATE SUPERVISOR SALARY REASON FOR LEAVING 2150 North California -- course work complete EMPLOYER FROM - MOJYR. .I TO - MOJYR. I ADDRESS IMMEDIATE SUPERVISOR SALARY REASON FOR 15. HAVE YOU EVER BEEN EMPLOYED . IF YES. GIVE DEPARTMENT NAME FROM TO BY THE CITY 15. HAVE YOU EVER BEEN DISOUALIFIED . IF YES. WHAT DATE DISDUALIFIED REASON FOR ANY CARER SERVICE I3 YES I 17. COMPUTER SKILLS: CHEOKTHE BOXES THAT APPLY: HIT PAIR NONE EXPERT FAIR WORDPHIFEDT OTHER (PLEASE SPECIFY) El E1 OUAITRO - PRO E1 PARADOX El LOTUS 1-2WINDOWS CI OI El 5' 18. ADDITIONAL SKILLS AND ABILITIES: I I I 7mm; wen: 40 {swarms m: 0 :mcm'uoue 40 lcamupm WM: 5 5 OTHER: 19. LIST 3 ADULTS WHO KNOW YOU WELL ENOUGH TO GIVE INFORMATION CONCERNING YOU AND YOUR EMPLOYMENT HISTORY. ADDRESS 8: CITY) OCCUPATION In. a PERSONAL HISTORY QUESTIONNAIRE BACKGROUND INVESTIGATION CHICAGO POLICE DEPT. 1.. POSITION APPUED EXAM NOW. 2. DATE POLICE OFFICER (DAY-MONTH-YEARJ 6Q 73m (50 3. NAME (LAST - MIDDLE INITIAL) 5. HOME PHONE 6. BUSINESS PHONE Neal, mime I u. mum?Hm, 4. MAIDEN NAME (IF APPL) 7. HOME ADDRESS (STREET NUMBER 8- NAME - APARTMENT NUMBER - CITY STATE - ZIP CODE - COUNTY) 8. SOCIAL SECURITY INSTRUCTIONS PRINT OR TYPE ALL INFORMATION IT IS IMPORTANT TO READ THESE INSTRUCTIONS CAREFULLY AND TO SIGN THE AUTHORIZATION EOR RELEASE PERSONAL INFORMATION CONTAINED ON THE BACK COVER OF THIS QUESTIONNAIRE. . You must be complete and truthful in all your answers. All answers that you give in this application are subject to veri?cation. Any failure to report compietely or any untruthful answers will subiect you to rejection as a candidate. You are not required to disclose your HIV status in response to any question herein. In this questionnaire, a number of items ask for simple "yes" and "no" answers and do not require any explanation. However, if you wish to explain your answers, use the CONTINUATION SECTION on page 10 Of this questionnaire. Before each answer or explanation, write the item number for reference. Do not leave any question blank. if a question does not apply to you, write {Abbreviation for "Not Applicable"). Your answers must be legible. Do not disclose any medical or conditions in response to any question herein, DISCLAIMER I understand that the processing of this Personal History Questionnaire is not a guarantee of employment or hire as a Probationary Police Of?cer or the position applied for. I further understand that consideration for employment is dependent upon my successful completion Of all steps of the process for this position and upon the availability of a budgeted position for Probationary Police Of?cer or the position applied'fOr. I have read and understand all of the instructions pertaining to this Personal History Questionnaire and the Content of the ab0ve disclaimer. DATE (DAY - MONTH - YEAR) 30 3% (Do 9. SIGNATURE (APPLICAN CPD - 62.152 (REV. 02/95) PAGE 1 {a 39. EMPLOYMENT: LIST IN PROPER TIME SEQUENCE ALL PART-TIME AND TEMPORA PRESENT OR MOST RECENT JOB FIRST. EXPLAIN ALL GAPS IN EMPLOYME RYJOBS YOU HAVE HELD. UST YOUR NT IN THE CONTINUATION SECTION. 1, NAME (MOST RECENT) PHONE NUMBER MO YR To MO YR ENS, AIDA ESL. \y Q??cum?5 $00 0 PM In: ISO ADDRESS {Inna STATE. CODE) TYPE OF BUSINESS YOUR TITLEIPOSITION 3 (5 wk Ram CRL-ugu . Image: Seale WMP/I?igmec. EXPLAIN WHAT YOUR DUTIES WERE IMMEDIATE SUPERVISOR REASON FOR LEAVING I mm AEIW mid 2. EMPLOYERS NAME PHONE NUMBER limf ADDRESS (CITY. STATE, ZIP COTE) TYPE OF BUSINESS YOUR TIT SEPIA I??kmm EXPLAIN WHAT YOUR DUTIES WERE IMMEDIATE SUPERVISOR REASON FOR LEAVING GROW Ewan: ?gbgos 3. NAME PHONE NUMBER MO YR TO MO YR DIM "3.1 ?9ch ADDRESS I (CITY, STATE, ZIP CODE) TYPE OF BUSINESS YOUR Qt cs?ku?oo?. .13 ML. ERIK QASRI at? EXPLAIN WHAT YOUR DUTIES WERE IMMEDIATE SUPERVISOR REASON FOR LEAVING SILVER: 4. NAME PHONE NUMBER MO YR TO MO YR Wsamnnx was-\- ADDRESS (CITY, STATE. ZIP CODE) TYPE OF BUSINESS YOUR Quail x?mA . EAR: EXPLAIN WHAT YOUR DUTIES WERE IMMEDIATE SUPERVISOR REASON FOR LEAVING I 5. NAME PHONE NUMBER ADDRESS (CITY, STATE, ZIP CODE) TYPE OF BUSINESS YOUR EXPLAIN WHAT YOUR DUTIES WERE IMMEDIATE SUPERVISOR REASON FOR LEAVING 6. EMPLOYERS NAME PHONE NUMBER ADDRESS (CITY, STATE, ZIP CODE) TYPE OF BUSINESS YOUR TITLEIPOSITION EXPLAIN WHAT YOUR DUTIES WERE IMMEDIATE SUPERVISOR REASON FOR LEAVING 7. EMPLOYERS NAME PHONE NUMBER ADDRESS (CITY, STATE, ZIP CODE) TYPE OF BUSINESS YOUR EXPLAIN WHAT YOUR DUTIES WERE IMMEDIATE SUPERVISOR REASON FOR LEAVING CPD - 62.152 (REV. 0285) PAGE 5 DANIEL NEUBECK OBJECTIVE: To obtain a position with the Independent Police Review Authority. WORK EXPERIENCE: CLAIMS BUREAU USA Special Investigator December 2005 - Present I Responsible for conducting surwillance and investigations on individuals throughout the United States handling approximately 10 cases or more per month I Conduct in-depth face-to-face interviews I Accountable for producing completed detailed reports on each investigated case Regional Manager I Manage key customer accounts covering the Central and Western United States I Supervise 20 ?eld agents and administer their daily tasks I Communicate and update customers on progress of current cases resulting in zero customer loss I Process and bill out approximately 40 reports with 100 on-time delivery of each OAKLAND COUNTY OFFICE March 2006 - Present Marine Deputy I Responsible for enforcing state and local laws with zero citizen complaints I Con?ict resolution through learned negotiation and investigative techniques I Perform job duties to 100% ef?ciency under extreme, high-stress situations PRENIIER CLAIMS INVESTIGATIONS November 2003 - February 2004 Private Investigator I Conducted surveillance on individuals in the state of Michigan I Utilized investigative techniques to help prove each case I Produced completed reports on each investigated case EDUCATION: GRAND VALLEY STATE UNIVERSITY August 2000 Augut 7, 2003 Allendale, Michigan Bachelor of Science, Criminal Justice Police Academy - Grand Valley State University April 2003 - August 7, 200% Michigan Commission on Law Enforcement Standards Certi?able ACCOMPLISHMENTS: I Scott Graham Memorial Volunteer Award I Steve Secatch Memorial Scholarship QUALIFICATIONS: Licensed Investigator in Michigan, Iowa, Illinois, Indiana Investigative Techniques Training Advanced First certi?ed Trained in Verbal Judo PPCT Defensive Tactics Pro?cient in Microso? Of?ce Applications DO NOT WRITE IN THIS SECTION I UUES I IONNAIRE DATE CHICAGO POLICE DEPARTMENT POSITION . 9 I ?0 ragf? 0535' INSTRUCTIONS: Answer alt questions accurately and completely. You will be disqualified for any false '51" N0 statements. PRINT all information in ink. List additional inform_a_t_ian In thrnarks Section. NAME 2. MAIDEN NAME I OLVEM 1:1 3. HOME ADDRESS (STREET NO.. NAME. CITY. ZIP CODE) 4. HOME TELEPHONE NO. i 3 SOURCE 6. BUSINESS TELEPHONE No. UN IT DF ASSIGNMENT 5.50CIAL SEC 439* 63a 0 7. DO YOU HAVE A VALID DRIVERS IF YES. GIVE NUMBER YES DNO . LIST ANY PHYSIC HAD 0R CURRENTLY HAVE THAT WOU LD PREVENT YOU FROM PERFORMING THE I OR DISEAS ACTIVITIES REQUI RED OF THE POSITION FOR WHICH YOU ARE APPLYING. DNA 9. DID YOU SERVE IN THE U.S. ARMED IF YES. BRANCH OF SERVICE 10. DATE ENTERED ARMEDSERVICE {If 0 . 11. DATE DISCHARG ED 12.- RANK AT DISCHARGE 13. TYPE OF DISCHARGE 14. ARE vou A HIGH SCHOOL No. How MANY YEARS OF SCHOOL. DID YOU ATTENOI KING 5 Elves EINO I FROM To NAME OF SCHOOL 5TATE MOJYR. MOJYR. YES 5 No #935316? a A. 6 3 ATTENDED QSIMIK . 0 7? 5? JUNIOR COLLEGE 3 COLLEGE OR 3 Lot/0L ,4 (Mil mes; I did/mam) 8/23 5/27 WE 5 . a?w?izmy mama 9/40 9/90 {2%,ng ?355?. IF Yo]? mama ADDITIONAL SPACE. INDICATE THE QUESTION You ARE ANSWERING. THEN CONTINUE YOUR ANSWER BELOW. (?uid! 234/; P6 REMARKS SECTION CPD-62.200 (Rev. 1/86) CONTINUE ON REVERSE APPLICANT QUESTIONNAIRE PAGE NAME I Er 15- LIST PRESENT PREVIOUS EMPLOVMENT IN CHRONOLOGICAL ORDER FOR THE PAST 5 YEARS. START WITH THE PRESENT. -A. EMPLOYER (MOST RECENT) POSITION LEM ?ax/m7? dry/gnu {@5551}; ADDRESS IMMEOI SALA RV EASON FOR LEAVING M?i?Mn/? a; .845;an B. EMPLOYER POSITION TO-MOJYR. Me 0.5 AGE/veg9/70 ADDRESS IAT SALARY REASON FOR LEAVINO 25%) ?156ij DES ?aw/g ?5 55AM) FROM-MOJYR. TO-MOJY R. .0640 i?ug ?zz/c. lass 5mm}; 7/37 ,9/37 1% We? Wde ?wgma?gg?gg D. EMPLOYER POSITION mugs (9. Mum/12M, 52w 695M a;wa 9/35? 7/97 ADDRESS IMMEDIATE SUPERVISOR EAL-ARV #9 ASON FOR LEAVING (gnaw: U, ?lm/amid ?air}? 16- HAVE YOU EVER BEEN EMPLOYED IF YES. DE TMENT FROM TO BY THE CITY OF IZINO I 17- HAVE YOU EVER BEEN DISQUALIFIEQ IF YES. WHAT POSITION DATE DISQUALIFIED REASON FOR ANY CAREER SERVICE DYFR run 15. LIST SPECIAL SKILLS. TEHINING, EXPERIENCE, SUCH- AS TYPING. SHORTHAND, LANGUAGE ETC. INDICATE LEVEL OF ABILITY ORSPEED. Wad/Md 600%: [5 51-h?; [Way/$65 ftp/W? Mob/?3065 ?hs?mu EMPLOYMENT BACKG ROUND I - 19- LIST 3 RESPONSIBLE ADULTS WHO KNOW YOU WELL ENOUGH TO GIVE INFORMATION CONCERNING YOU. NAME I ADDRESS (NO., STREET 8; OCCUPATION (KHz/c- mr?wrm Qua; 154m 2%g35az REFERENCES I 2725. ?9 K?s/f/m/ Jr?s/243' 193 m: a/ngyg; 740% MM {77/ x413 Mmer LEFT ME 70 Am a; 57:45.45 ?ssawm, WWO Maze Ema?um 779 7m; J?maz?s y; ray. 16c Nag/<20 7am from Lama/125; M957 u. lwaw m: 37 N. Tm Sa/emsac;? ?aw/mauazf/AWQW) HR. JIM 7/4/1110 . ADDITIONAL REMARKS City of Chicago Department of Personnel Room 1100 - City Hall 121 N. LaSalle Street Chicago, Illinois 60602 PERSONNEL DATA FORM PLEASE PRINT- PRESS FIRMLY FOR OFFICE USE: DATE I I NAME BIRTHDATE I . - MALE .35; -. Ll Last First MI. FEMALE PRESENT ADDRESS Apt No. or RC Box Home Pho I EMERGENCY CONTACT: EDUCATION LEVEL: (The following definitiorrs are those used by the United States Equal Employment NAME YEARS COMPLEFED- Graduated pportuni-ty Commission. This information will be used for statistical purposes only.) 1. Grade School Yes No ADDRESS a: 1.WHITE ILASIAN or PACIFIC 2. ngI'l School .BLACK HIGHEST 5. AMERICAN INDIAN - - .x DEGREE. AA BNBS El El Ph 3. HISPANIC NATIVE El RELATIONSHIP - LICENSES HELD: LLB. CITIZEN IF YOU ARE NOT A US CITIZEN ANSWER THE FOLLOWING: A . COUNTRY OF MILITARY RECORD: L.- Yes No ARE YOUAPERMANENT RESIDENT ALIEN Yes No CITIZENSHIP Were you In the Armed Serwce? DISABILITIES Do you wish to he considered FOREIGN LANGUAGES (Enter Language. Then indicate level by entering box. 3 HANDICAPS for handicaoped status? Yes No Emenem, r: Pam pom?J Yes No 's If yes, please describe: a Branch {in ?1 - M1 . Slacker-l r! From: Mo. Year Written To: Mo. Year Present Status Read [1 FHA I - 5 Dates Attended Greens Degree. Ioma DUCA ONI IN GlCoiege ausmess or fades moo} Compleleu or Germ;an Rig!in School Name Citv Slale Field of Study 59Cg73til-L" PRIOR EMPLOYMENT HISTORY (Les: 3} ADDRESS KIND OF BUSINESS FROM TO JOB TITLE - '33? -4: -. I . 2-3.: 4: ?3 inK530 7? 7 5?7 r; 7-54.71. ?lillE DEPARTMENT OF PERSONNEL COP IBM HIRING DEPARTMENT COPY AN EQUAL ACTION EMPLOYER PER-63 REV 8181 GEORGE ROBERTS PROFILE Management: Participate in Department?s budget forecast; Conduct interviews of applicants for Inspector/Investigator position; Complete detailed employee performance evaluations with recommendations for improvement; Participate and contribute to weekly Supervisor?s meetings; Update upper levels of management on various on going Investigations. Technical: Coordinate and expand Department?s audio-video programs; Interface video technology using computer programs to produce state of the art clear evidence of Investigations; Pro?cient Microsoft Of?ce Skills and numerous database skills. Pro?cient with various computer operating systems including Windows 95, 98, 2000, NT, XP and Professional. Familiarity with Windows Vista. Investigative Skills: Proven ability to coordinate large scale investigations involving numerous interviews; Ability to coordinate large scale sensitive investigations as a sole investigator or as a team leader; Proven ability to supervise Investigators to maximize production; Proven ability to communicate effectively orally and in writing. EXPERIENCE City of Chicago? Chicago Fire Department (Internal Affairs Division) IN VESTIGATOR SPECIALIST 2004 PRESENT Interview dif?cult or uncooperative complainants, witness and employees to gather facts and investigate alleged criminal activities Function as a lead investigator on large scale investigations requiring the coordination of investigative activities by a team of investigators Prepare detailed reports of investigation conducted including ?ndings and makes disCiplinary recommendations Testify in court, arbitration hearings and Personnel Boards on investigations conducted and ?ndings Evaluate and investigate applicants for sworn positions with the Chicago Fire Department Obtain criminal and court records of applicants from city, state and federal agencies Respond to Emergency accident sites to conduct medical testing of sworn members following motor vehicle accidents which includes obtaining urine samples and breath analysis Ii i R. ROBERTS City of Chicago- Department of Environment SUPERVISING ENVIRONMENTAL INSPECTOR 2000 - 2004 Direct and oversee the activities of Senior Environmental Inspectors Assign, monitor, review and evaluate routine inspections conducted by Senior Environmental Inspectors Edit all Inspection reports submitted by Senior Environmental Inspectors for accuracy and completeness Act as a co-incident commander and incident supervisor on hazardous materials emergencies Issue citations to violators of the city municipal code, state code and federal law Provide initial inspections of industrial and disposal sites to ensure public health and safety Provide expert testimony in court proceedings Respond to citizen?s complaints concerning alleged sources of environmental pollution Conduct investigations of citizen complaints by performing inspections and utilizing interviewing skills Act as Department?s spokesman at community meetings answering citizens questions and inquires City of Chicago- Department of Environment SENIOR ENVIRONMENTAL INSPECTOR 1989 - 2002 Conduct inspections of business and residential occupancies to enforce city, state and federal law Complete detailed reports regarding Inspections and Investigations Issue citations to violators of the city municipal code, state code and federal law Provide initial inspections of industrial and disposal sites to ensure public health and safety Provide testimony in court proceedings Act as a co-incident commander and incident supervisor on hazardous materials emergencies Respond to citizen?s complaints concerning alleged sources of environmental pollution Conduct investigations of citizen complaints by performing inspections and utilizing interviewing skills City of Chicago- Department of Consumer Services ENVIRONMENTAL DISPATCH CLERK 1989 Received citizen?s complaints concerning potential environmental hazards i130 RGE R. ROBERTS Operated radio and telephone communications equipment in connection with routine assignments, vehicle breakdowns and other emergency situations Dispatched the appropriate amount of manpower to emergency situations City of Chicago- Department of Aviation AIRPORT OPERATIONS AIDE 1986 - 1989 Operated computer and radio dispatch equipment to airport personnel on air?eld Received requests for information and assistance and relayed all requests to the appropriate airport personnel Logged all calls and actions taken Maintained detailed records of actions taken to resolve problems Issued notices to pilots, to notify in-coming aircraft or air?eld hazards and changes Transmitted weather information and air?eld conditions to airport personnel and airlines EDUCATION GOVERNORS STATE UNIVERSITY, University Park, IL Masters of Arts in Political and Justice Studies December 2001 NORTHEASTERN ILLINOIS UNIVERSITY, Ch icaga IL Bachelor of Arts in Criminal Justice (Cum Laude) August 2000 LOOP COLLEGE, Chicago, IL Associate Degree in Liberal Arts May 1988 QUESTIONNAIRE CHICAGO POLICE DEPARTMENT DA TE DO NOT WRITE IN THIS SECTION matoiufi? NSTRUCTIONS: Answer all questions accurately and compietely. You will be disquanned for?a'ny false Remarks Section. .tatements. PRINT an information in Inlg._L.ist additional information in .. NAME NLI.) 2. MAIDEN NAME sancbr? a PIQQ CODE) ADDRESS (STREET NO.. NAME, CITY. ZIP 5.5 . DID YOU HAVE A VALID DRIVERS IF YES, GIVE NUMBER CINO 4. HOME TELEPHONE ND. 259,223" 225? 5992: Mia/Mi EMPLO gas. MST UNIT Azeguam- 1. LIST ANY FI-IYSICA IGTIVITIES REQUIRED OF THE POSITION FOR WHICH YO Norma. HAD DR CURR ARE APPLYIN ENTLY HAVE THAT WOULD PREVENT YOU FROM PERFORMING THE 9. DID YOU SERVE IN THE U.S. ARMED IF YES. BRANCH OF SERVICE 10. DATE ENTERED ARMED SERVICE 11. DATE DISCHARGED MILITARY 12. RANK AT DISCHARGE 13. TYPE OF DISCHARGE .14. ARE YOU A HIGH SCHOOL ES Elmo IF NO. DID YOU GET A CINE: . IF NO. HOW MANY YEARS OF SCHOOL DID YOU NAM SCHOOL CITY STATE FROM MOJYR. TO YES 1ND LAST HIGH SCHOOL ATTENDED Champ JUNIOR COLLEGE 2/35 SISO l. CHI. 0 T. balm:3 COLLEGE OR Chm;- UNIVERSITY TRADE OR BUSINESS SCHOOL II. QUEST. ND. IF YOU NEED ADDITIONAL INDICATE THE QUESTION YOU ARE ANSWERING. THEN CONTINUE YOUR ANSWER BELOW. M75 in] /7 55? f5? 30-62200 (Rev. 1/36) CONTINUE ON REVERSE EPIC Sa?dg-S 15- LIST PRESENT PREVIOUS EMPLOYMENT IN CHRONOLOGICAL ORDER FOR THE PAST 5 YEARS. START WITH THE PRESENT. A. EMPLOYER (MOST RECENT) - POSITION AKA mLamE-E 5 E439 LEIEIL- ISOR REASON FOR LEAVING I LL 84 EMF YER .m POSITION Thee-Ira, 9I 56. 5I89 ADDRESS IMMEDIATE SUPERVISOR SALARY REASON FOR LEAVING I C. EM OVER TO-MO. YR. I SALARY REASON OR LEAVING D. EMPLOYER EMPLOYMENT BACKGROUND h?F-d' ADDRESS 3; ARY REASONF-ORLEAYG 16. HAVE YOU EVER BEEN EMPLOYED DEPARTMENT FROM TO BY THE CITY OF - A - 17. HAVE YOU EVER BEEN DISQUALIFIED IF YEs, WHAT POSITION OATE DISQUALIFIED REASON FOR ANY CAREER SERV1 I 18. LIST SPECIAL SKILLS, TRAINING. EXPERIENCE. SUCH AS TYPING, SHORTHAND, LANGUAGE SPOKEN, ETC. INDICATE LEVEL OF ABILITY ngI?afb owa?mj a 46m 2333103. I 19- LIST 3 RESPONSIBLE ADULTS WHO KNOW YOU WELL ENOUGH TO GIVE INFORMATION CONCERNING YOU. OCCUPATION AssI'Scawt Lm?a?wr NAME ADDRE -ET REFERENCES ADDITIONAL REMARKS APPLICANT QUESTIONNAIRE DATE DO NOT WRITE IN THIS SECTION CHICAGO POLICE DEPARTMENT TIDN W93 IM INSTRUCTIONS: Answer all questions accurately and completely. YOU will be disqualified for any false statements. PRINT all informatiOI-I in ink. List addltiOI?Ial information in Remarks Suction. 2? a} 1. NAME 2. MAIDEN NAME EMP 3 @5219 Lei/.5 m. We 3. HOME ADDRESS (STREET NO.. NAME, CITY, ZIP CODE) . 4. HOME TELEPHONE NOUSINES7ELEPHDNE NO. 0F ASSIGNMENT 4- 3 VE A VALID DRIVERS IF YES. GIVE NUMBER E5 END 3. LIST ANY PHYSIC OISASILITY OR DISEASE YOU AD OR CURRENTLY HAVE THAT WOULD PREVENT YOU FROM PERFORMING TI-IE ACTIVITIES REQUIRED OF THE POSITION FOR WHICH YOU ARE APPLYING. 9. DID YOU SERVE IN THE US. ARMED IF YES. BRANCH SERVICE 10. DATE ENTERED ARMEDSERVICE I .5 DYES Ego - 5 11. DATE DISCI-IA RGED 12. RANK AT DISCHARGE TYPE OF DISCHARGE a 14. ARE YOU A HIGH SCHOOL NO, HOW MANY YEARS OF SCHOOL DID YOU UNO DYES EINO NAME OF 1 FROM TO SCHOOL CITY II. STA MONK MOJYR YES NO LAST HIGH 3 SCHOOL -- M: ATTENDED JUNIOR COLLEGE a 5 COLLEGE OR . UNIVERSITY Wye/?5?? TRADE OR 5 SUSINESS SCHOOL IF YOU NEED ADDITIONAL SPACE. INDICATE THE QUESTION You ARE ANSWERING. THEN CONTINUE YOUR ANSWER BELOW. 749675 7&67 75/ 'i?w REMARKS SECTION CPD-62.200 (Rev. 1/86) CONTINUE ON REVERSE 3.3059924 I 1.90m EMPLOYMENT IACKGROUND Hm- .2 030m.? 4.1m a ?mr 4Im .3313 10m .3244 ?lmy?mm? ?NRC-hum - a 5.30.30 :50 mm.? 3 0024.02 . . .2, 40.30.34? no? 00m. 330 $3.00 $3.3 1 .. .zzm054m artful. nmbmoz a ?09520 .. . mpwmanr04m mmbmoz Hm. Em? utmngil mlerm. 43312.20. mZOm. anI Pm 4/4329. EZQCPOM M?oxmz. Fm