DP-6
THE UNIVERSITY OF TEXAS
SYSTEM POLICE
EVIDENCE ORGANIZER AND REPORT OF
BACKGROUND INVESTIGATION
APPLICANT :
FIRST, MI, LAST
INVESTIGATOR:
RANK/TITLE, FIRST, LAST
UTSP EVIDENCE ORGANIZER AND REPORT OF BACKGROUND INVESTIGATION
DP-6
INSTITUTION: Use this drop down menu to select your institution. Click the institution name, and the “down arrow”
will appear to the right of the field. The “down arrow” is only active when the document is locked. Click the “down
arrow” to choose other institutions.
UT ARLINGTON
BACKGROUND INVESTIGATOR(S)
Name
Signature
Date
Phone:
/
/
/
/
Email:
Phone:
Email:
Reviewer(s)
Name
Signature
Date
Phone:
/
/
/
/
Email:
Phone:
Email:
DOES THE APPLICANT MEET MINIMUM STANDARDS? Use the “drop down” menu to indicate if the
applicant does or does not meet the minimum standards to become a police officer. Click the “down arrow” to the right
of the field to choose the appropriate condition. To put a “check” in the check boxes, click the box with your mouse.
The “down arrow” and the “check box” functions are only active when the document is locked.
Applicant meets minimum standards
If this applicant is rejected, is he/she eligible for reconsideration at a later date?
Yes
No
When?
/
/
GENERAL REPUTATION
Investigator Instructions: APPLICANT’S GENERAL REPUTATION
 Describe the applicant’s general reputation for the position sought.
 For categories that require explanation, use complete sentences and thorough detail. The typing form fields will
expand to accommodate the needs of the user.
 An answer must be submitted for all categories listed below.
 Clarify the positive qualifications the applicant possesses such as
o Degrees such as Bachelors and Masters
o High Awards
o Excellent Evaluations
 Clarify the negative qualifications the applicant possesses such as
o Drug use
o Terminations
o Significant traffic issues
o Serious undetected acts
GENERAL REPUTATION
What is the general reputation of the applicant?
Page 2 of 32
UTSP EVIDENCE ORGANIZER AND REPORT OF BACKGROUND INVESTIGATION
What positive qualities do people say the applicant brings to policing?
What negative qualities does the applicant possess?
Has the applicant ever lost his or her temper?
Yes
No
If so, what was the situation? Explain:
NOTES or Addition Information: the typing field expands to accommodate the needs of the user.
Page 3 of 32
DP-6
UTSP EVIDENCE ORGANIZER AND REPORT OF BACKGROUND INVESTIGATION
DP-6
Table of Contents
GENERAL REPUTATION .................................................................................................................................2
APPLICANT INFORMATION ...........................................................................................................................5
LAW ENFORCEMENT APPLICATIONS.........................................................................................................6
MARITAL AND FAMILY HISTORY ...............................................................................................................8
FRIENDS, ASSOCIATES, RELATIVES & FAMILY RELATIONS................................................................9
CONTACTS ......................................................................................................................................................10
EDUCATION HISTORY ..................................................................................................................................12
WORK HISTORY .............................................................................................................................................14
UNEMPLOYMENT RECORD .........................................................................................................................16
MILITARY RECORD .......................................................................................................................................17
FINANCIAL HISTORY ....................................................................................................................................18
CRIMINAL HISTORY .....................................................................................................................................20
CIVIL LITIGATION HISTORY .......................................................................................................................23
TRAFFIC RECORD ..........................................................................................................................................25
PERSONAL AND EMOTIONAL HISTORY ..................................................................................................27
HISTORY OF NARCOTICS AND CONTROLLED SUBSTANCES .............................................................28
HISTORY OF ALCOHOL USE........................................................................................................................29
MEMBERSHIPS IN GROUPS, ASSOCIATIONS OR CLUBS ......................................................................30
SOCIAL MEDIA ...............................................................................................................................................31
Page 4 of 32
UTSP EVIDENCE ORGANIZER AND REPORT OF BACKGROUND INVESTIGATION
DP-6
APPLICANT INFORMATION
NAME OF APPLICANT:
First Name
Middle Name
Not Applicable
Last Name
Suffix
MAIDEN NAME:
First Name
Middle Name
Last Name
APPLICANT INFORMATION
Date of Birth:
Driver’s License
Information:
/
/
City:
Place of Birth
State:
Lic. #:
State:
Country:
Social Security Number:
-
-
Current Street Address:
State:
City:
Phone
Number(s):
Cell Phone
Email Adresses:
1)
(
)
-
ZIP:
Home Phone
Work Phone
Other Phone #1
Other Phone #2
(
(
(
(
)
-
2)
)
-
)
-
3)
PROFESSIONAL CERTIFICATION INFORMATION:
PID#:
TYPE OF CERTIFICATION:
Police Officer
Temporary Telecommunicator
Proficiency Rating:
License
Instructor
Basic
Jailer
Intermediate
Firearms Instructor
Telecommunicator
Temporary Jailer
Advanced
Master
Mental Health Officer
NOTES or Addition Information: the typing field expands to accommodate the needs of the user.
Page 5 of 32
)
-
UTSP EVIDENCE ORGANIZER AND REPORT OF BACKGROUND INVESTIGATION
DP-6
LAW ENFORCEMENT APPLICATIONS
Investigator Instructions: LAW ENFORCEMENT APPLICATIONS
 List all law enforcement applications submitted by the applicant; include agency, status of application, whether or
not a background was completed, and the results of the background. Insert additional entries as needed.
 Include all full time, part time, temporary, self-employment and volunteer positions.
 For categories that require explanation, use complete sentences and thorough detail. The “Notes” and “Explain”
fields expand as you type.
 An answer must be submitted for all categories listed below. If the category is “Not Applicable” to the applicant,
note that fact as the answer to the category.
Not Applicable
LAW ENFORCEMENT APPLICATION #1
Date Applied:
/
/
Agency Name:
City
State
Agency Contact # Street Address
Information:
Agency Phone Number(s): (
)
(
)
(
Title Applied For:
Status of Application:
Police Officer
Other Explain:
Telecommunicator
ZIP
)
-
Deputy
(
)
-
Guard
Hired
Withdrawn
On List
Other (Use Notes section to explain)
Disqualified?
Failed Exam
Failed Interview/Board
Failed Physical Agility Test
Given a re-application date? Explain:
Background completed by agency?
Yes
No
Results:
Name of Background Investigator:
Notes: The typing field expands to accommodate the needs of the user.
Not Applicable
LAW ENFORCEMENT APPLICATION #2
Date Applied:
/
/
Agency Name:
City
State
Agency Contact # Street Address
Information:
Agency Phone Number(s): (
)
(
)
(
Title Applied For:
Status of Application:
Police Officer
Other Explain:
Telecommunicator
ZIP
)
-
Deputy
(
)
-
Guard
Hired
Withdrawn
On List
Other (Use Notes section to explain)
Disqualified?
Failed Exam
Failed Interview/Board
Failed Physical Agility Test
Given a re-application date? Explain:
Background completed by agency?
Yes
No
Results:
Name of Background Investigator:
Notes: The typing field expands to accommodate the needs of the user.
Not Applicable
LAW ENFORCEMENT APPLICATION #3
Date Applied:
/
/
Agency Name:
City
State
Agency Contact # Street Address
Information:
Agency Phone Number(s): (
)
(
)
(
Page 6 of 32
ZIP
)
-
(
)
-
UTSP EVIDENCE ORGANIZER AND REPORT OF BACKGROUND INVESTIGATION
Title Applied For:
Status of Application:
Police Officer
Other Explain:
Telecommunicator
DP-6
Deputy
Guard
Hired
Withdrawn
On List
Other (Use Notes section to explain)
Disqualified?
Failed Exam
Failed Interview/Board
Failed Physical Agility Test
Given a re-application date? Explain:
Background completed by agency?
Yes
Results:
No
Name of Background Investigator:
Notes: The typing field expands to accommodate the needs of the user.
ADDITIONAL LAW ENFORCEMENT APPLICATION #
Not Applicable
Unlock the document, copy this block, and add the number of application it represents. Copy as many times as is
needed to complete the document. Re-lock the document after copying to maintain form field integrity.
Date Applied:
/
/
Agency Name:
Agency Contact # Street Address
Information:
Agency Phone Number(s): (
)
Title Applied For:
Status of Application:
Police Officer
Other Explain:
City
(
State
)
-
Telecommunicator
ZIP
(
)
Deputy
-
(
)
Guard
Hired
Withdrawn
On List
Other (Use Notes section to explain)
Disqualified?
Failed Exam
Failed Interview/Board
Failed Physical Agility Test
Given a re-application date? Explain:
Background completed by agency?
Yes
No
Results:
Name of Background Investigator:
Notes: The typing field expands to accommodate the needs of the user.
Page 7 of 32
-
UTSP EVIDENCE ORGANIZER AND REPORT OF BACKGROUND INVESTIGATION
DP-6
MARITAL AND FAMILY HISTORY
Investigator Instructions: MARITAL, SERIOUS RELATIONSHIPS FAMILY HISTORY
 List all the applicant’s marriages, serious relationships and / or divorces. Insert additional entries as needed.
 For categories that require explanation, use complete sentences and thorough detail. The typing form fields will
expand to accommodate the needs of the user.
 An answer must be submitted for all categories listed below. If the category is “Not Applicable” to the applicant,
note that fact as the answer to the category.
Not Applicable
MARRIAGE / SERIOUS RELATIONSHIP / COMPANION #1
Name:
Phone: (
Contact Information: # Street Address
)
City
State
ZIP
-
Dates of the relationship:
/
/
to
/
List Children of the Relationship/Marriage:
/
Date of Divorce/Separation:
Not Applicable
(First Name
Last Name
/
/
Age)
Reason(s) for the Divorce/Separation (Explain):
Results of Interview with Spouse / Ex-member of Relationship:
Notes:
Not Applicable
ADDITIONAL MARRIAGE / SERIOUS RELATIONSHIP / COMPANION #
(Unlock the document, copy this block, and add the number of marriage/relationship it represents. Copy as many times as
is needed to complete the document. Re-lock the document after copying to maintain form field integrity.
Name:
Phone: (
Contact Information: # Street Address
)
City
State
-
Dates of the relationship:
/
/
to
/
List Children of the Relationship/Marriage:
/
Date of Divorce/Separation:
Not Applicable
Reason(s) for the Divorce/Separation (Explain):
Results of Interview with Spouse / Ex-member of Relationship:
Notes:
Page 8 of 32
(First Name
Last Name
/
/
Age)
ZIP
UTSP EVIDENCE ORGANIZER AND REPORT OF BACKGROUND INVESTIGATION
DP-6
FRIENDS, ASSOCIATES, RELATIVES & FAMILY RELATIONS
Investigator Instructions: APPLICANT’S FRIENDS, ASSOCIATES, RELATIVES & FAMILY RELATIONS
 Describe the applicant’s friends, associates, relatives & family for the position sought.
 For categories that require explanation, use complete sentences and thorough detail. The typing form fields will
expand to accommodate the needs of the user.
 An answer must be submitted for all categories listed below. If the category is “Not Applicable” to the applicant,
note that fact as the answer to the category.
FRIENDS, ASSOCIATES, RELATIVE & FAMILY RELATIONS
What is the general reputation of the applicant’s friends, associates, and family relations?
Does the applicant have any friends, associates, and relatives who repeatedly break the law?
If so, to what extent is the applicant’s association with such persons?
Was the applicant aware of the criminal behavior of friends?
NOTES or Additional Information: the typing field expands to accommodate the needs of the user.
Page 9 of 32
UTSP EVIDENCE ORGANIZER AND REPORT OF BACKGROUND INVESTIGATION
DP-6
CONTACTS
Investigator Instructions: CONTACTS
 List the persons contacted to corroborate the information in this document.
 Be sure to include the contact information.
 For additional information, please use the notes block at the end of the section.
Name:
Contact #1
Relationship to Applicant:
Address: #Street
Phone1: (
Phone2: (
Email :
)
)
-
City
State
ZIP
City
State
ZIP
City
State
ZIP
City
State
ZIP
City
State
ZIP
City
State
ZIP
Name:
Contact #2
Relationship to Applicant:
Address: #Street
Phone1: (
Phone2: (
Email :
)
)
-
Name:
Contact #3
Relationship to Applicant:
Address: #Street
Phone1: (
Phone2: (
Email :
)
)
-
Name:
Contact #4
Relationship to Applicant:
Address: #Street
Phone1: (
Phone2: (
Email :
)
)
-
Name:
Contact #5
Relationship to Applicant:
Address: #Street
Phone1: (
Phone2: (
Email :
)
)
-
Name:
Contact #6
Relationship to Applicant:
Address: #Street
Page 10 of 32
UTSP EVIDENCE ORGANIZER AND REPORT OF BACKGROUND INVESTIGATION
Phone1: (
Phone2: (
)
)
-
DP-6
Email :
Name:
Contact #7
Relationship to Applicant:
Address: #Street
Phone1: (
Phone2: (
Email :
)
)
-
City
State
ZIP
City
State
ZIP
City
State
ZIP
City
State
ZIP
Name:
Contact #8
Relationship to Applicant:
Address: #Street
Phone1: (
Phone2: (
Email :
)
)
-
Name:
Contact #9
Relationship to Applicant:
Address: #Street
Phone1: (
Phone2: (
Email :
)
)
-
Name:
Contact #10
Relationship to Applicant:
Address: #Street
Phone1: (
Phone2: (
Email :
)
)
-
NOTES or Additional Information: the typing field expands to accommodate the needs of the user.
Page 11 of 32
UTSP EVIDENCE ORGANIZER AND REPORT OF BACKGROUND INVESTIGATION
DP-6
EDUCATION HISTORY
Investigator Instructions: EDUCATION HISTORY
 List the high school from which the applicant graduated.
 List all colleges, universities and trade schools attended since high school. Insert addition entries as needed.
 For Categories that require explanation, use complete sentences and thorough detail. Typing form fields expand to
accommodate the needs of the user.
 An answer must be submitted for all categories listed below. If the category is “Not Applicable” to the applicant,
note the fact as the answer to the category.
Not Applicable
HIGH SCHOOL
Name of High School:
High School
Address:
# Street Address
GPA:
City
Graduation Date:
/
State
/
ZIP
Rank: #
out of
students.
Awards:
Suspensions or Expulsions:
Notes:
ADDITIONAL HIGH SCHOOL #
Not Applicable
Unlock the document, copy this block, and add the number of high school it represents. Copy as many times as is needed
to complete the document. Re-lock the document after copying to maintain form field integrity.
Name of High School:
High School
Address:
# Street Address
GPA:
City
Graduation Date:
/
State
/
ZIP
Rank: #
out of
Awards:
Suspensions or Expulsions:
Notes:
Not Applicable
COLLEGE OR UNIVERSITY
Name of College or University:
College or
University
Address:
GPA:
Degree:
# Street Address
City
Dates of Attendance:
College Credit
Associates
/
/
Bachelors
to
State
/
Master
Page 12 of 32
/
ZIP
Course of
Study:
Doctorate
Total Credit Hours:
students.
UTSP EVIDENCE ORGANIZER AND REPORT OF BACKGROUND INVESTIGATION
DP-6
Awards:
Academic Suspensions or Expulsions:
Notes:
ADDITIONAL COLLEGE OR UNIVERSITY #
Not Applicable
Unlock the document, copy this block, and add the number of college or university it represents. Copy as many times as
is needed to complete the document. Re-lock the document after copying to maintain form field integrity.
Name of College or University:
College or
University
Address:
GPA:
Degree:
# Street Address
City
Dates of Attendance:
College Credit
Associates
/
/
Bachelors
to
State
/
Master
Awards:
Academic Suspensions or Expulsions:
Notes:
Page 13 of 32
/
ZIP
Course of
Study:
Doctorate
Total Credit Hours:
UTSP EVIDENCE ORGANIZER AND REPORT OF BACKGROUND INVESTIGATION
DP-6
WORK HISTORY
Investigator Instructions: WORK HISTORY
 List employment information for all jobs held within the last 15 years from the date the packet is provided to the
applicant. Insert additional entries as needed.
 Include all full time, part time, temporary, self-employment and volunteer positions.
 For categories that require explanation, use complete sentences and thorough detail. The typing fields expand to
accommodate the needs of the user.
 Answer must be submitted for all categories listed below. If the category is “Not Applicable” to the applicant, note
that fact as the answer to the category.
Not Applicable
WORK HISTORY: Location #1
Company Name:
Employed from:
/
/
to
/
Applicant’s Title:
/
Describe Job Duties:
Performance Level:
Awards and Recognition received by applicant:
Work Related Issues? (terminations, discipline, tardiness, absenteeism, behavior or emotional problems, work relationship issues)
Explain:
Applicant’s Reason for leaving:
Applicant’s eligibility for rehire:
Other Information:
Notes:
Not Applicable
WORK HISTORY: Location #2
Company Name:
Employed from:
/
/
to
/
/
Applicant’s Title:
Describe Job Duties:
Performance Level:
Awards and Recognition received by applicant:
Work Related Issues? (terminations, discipline, tardiness, absenteeism, behavior or emotional problems, work relationship issues)
Explain:
Applicant’s Reason for leaving:
Applicant’s eligibility for rehire:
Other Information:
Notes:
Page 14 of 32
UTSP EVIDENCE ORGANIZER AND REPORT OF BACKGROUND INVESTIGATION
Not Applicable
DP-6
WORK HISTORY: Location #3
Company Name:
Employed from:
/
/
to
/
/
Applicant’s Title:
Describe Job Duties:
Performance Level:
Awards and Recognition received by applicant:
Work Related Issues? (terminations, discipline, tardiness, absenteeism, behavior or emotional problems, work relationship issues)
Explain:
Applicant’s Reason for leaving:
Applicant’s eligibility for rehire:
Other Information:
Notes:
ADDITIONAL WORK HISTORY: Location #
Not Applicable
Unlock the document, copy this block, and add the number of work history location it represents. Copy as many times as
is needed to complete the document. Re-lock the document after copying to maintain form field integrity.
Company Name:
Employed from:
/
/
to
/
/
Applicant’s Title:
Describe Job Duties:
Performance Level:
Awards and Recognition received by applicant:
Work Related Issues? (terminations, discipline, tardiness, absenteeism, behavior or emotional problems, work relationship issues)
Explain:
Applicant’s Reason for leaving:
Applicant’s eligibility for rehire:
Other Information:
Notes:
Page 15 of 32
UTSP EVIDENCE ORGANIZER AND REPORT OF BACKGROUND INVESTIGATION
DP-6
UNEMPLOYMENT RECORD
Investigator Instructions: UNEMPLOYMENT RECORD
 List all periods of unemployment over the last 15 years that were in excess of 30 days.
 If the applicant did not have any periods of unemployment, check the “Not Applicable” box below.
 Insert additional entries as needed.
 Double check the dates listed in the work history section for gaps in the employment record.
 For categories that require explanation, use complete sentences and thorough detail. The typing fields expand to
accommodate the needs of the user.
 An answer must be submitted for all categories listed below.
Not Applicable
UNEMPLOYMENT PERIOD #1
Dates of Unemployment:
/
/
to
Applicant began seeking employment again on:
/
/
/
/
What did the applicant do during the period of unemployment? (Temporary or contract work, Unemployment Insurance, etc.)
Explain:
Other Information:
Notes:
Not Applicable
UNEMPLOYMENT PERIOD #2
Dates of Unemployment:
/
/
to
Applicant began seeking employment again on:
/
/
/
/
What did the applicant do during the period of unemployment? (Temporary or contract work, Unemployment Insurance, etc.)
Explain:
Other Information:
Notes:
UNEMPLOYMENT PERIOD #
Not Applicable
Unlock the document, copy this block, and add the number of unemployment period it represents. Copy as many times as is
needed to complete the document. Re-lock the document after copying to maintain form field integrity.
Dates of Unemployment:
/
/
to
Applicant began seeking employment again on:
/
/
/
/
What did the applicant do during the period of unemployment? (Temporary or contract work, Unemployment Insurance, etc.)
Explain:
Other Information:
Notes:
Page 16 of 32
UTSP EVIDENCE ORGANIZER AND REPORT OF BACKGROUND INVESTIGATION
DP-6
MILITARY RECORD
Investigator Instructions: MILITARY RECORD
 Summarize the information from the applicant’s military paperwork. If the applicant was not in the military, check
the appropriate box below.
 For categories that require explanation, use complete sentences and thorough detail. The typing form fields expand
to accommodate the needs of the user.
 An answer must be submitted for all categories listed below. If the category is “Not Applicable” to the applicant,
note the fact as the answer to the category.
Not Applicable
APPLICANT’S MILITARY HISTORY (Unlock document and copy as necessary. Relock document)
Branch(es) of the Military
the applicant served in:
Induction Date:
/
/
ARMY
AIR FORCE
NATIONAL GUARD
Discharge Date:
Highest rank attained:
/
/
NAVY
RESERVE
MARINES
Rank at discharge:
COAST GUARD
Honorable?
Rank at discharge if different:
Disciplinary Problems: (Show dates, types of issues, and explain)
Name(s) of person(s) contacted to check unit disciplinary records:
Special Training / Skills:
Noteworthy Awards and Medals:
Notes:
Page 17 of 32
Yes
No
UTSP EVIDENCE ORGANIZER AND REPORT OF BACKGROUND INVESTIGATION
DP-6
FINANCIAL HISTORY
Investigator Instructions: APPLICANT’S FINANCIAL HISTORY
 List the requested financial information for the applicant and applicant’s significant other.
 For categories that require explanation, use complete sentences and thorough detail. The typing form fields will
expand to accommodate the needs of the user.
 An answer must be submitted for all categories listed below. If the category is “Not Applicable” to the applicant,
note that fact as the answer to the category.
APPLICANT’S CURRENT INCOME AND EXPENDITURES
Applicant’s Current Net Monthly Income (Salary and Other):
$
.
Source(s) of Income:
Net Monthly Income (Salary and Other) for Spouse/Serious Relationship/Companion:
$
.
Source(s) of Income:
Total Monthly Expenditures:
Housing:
Utilities:
Credit Card(s):
Loan(s):
$
.
Vehicle(s):
Credit Score:
$
$
$
$
.
.
.
.
$
.
Other (list):
$
$
$
$
$
$
$
$
Not Applicable
.
.
.
.
.
.
.
.
PAST-DUE ACCOUNTS
Company Name:
Number of Days Late:
Currently on a payment plan?
1.
Yes
No
2.
Yes
No
3.
Yes
No
4.
Yes
No
5.
Yes
No
Not Applicable
ADDITIONAL PAST-DUE ACCOUNTS #
Unlock the document, copy this block, and add the number of past due account it represents. Copy as many times as is
needed to complete the document. Re-lock the document after copying to maintain form field integrity.
Company Name:
Number of Days Late:
Currently on a payment plan?
Yes
Not Applicable
BANKRUPTCIES
Page 18 of 32
No
UTSP EVIDENCE ORGANIZER AND REPORT OF BACKGROUND INVESTIGATION
TYPE:
DATE:
1.
/
/
2.
/
/
3.
/
/
4.
/
/
5.
/
/
Not Applicable
DATE:
1.
/
/
2.
/
/
3.
/
/
4.
/
/
5.
/
/
TYPE:
DATE:
/
/
2.
/
/
3.
/
/
4.
/
/
5.
/
/
TYPE
REASON FOR:
ADDITIONAL BOUNCED CHECK #
Unlock the document, copy this block, and add the number of bounced check it represents. Copy as many times as is
needed to complete the document. Re-lock the document after copying to maintain form field integrity.
DATE:
/
Not Applicable
REASON FOR:
BOUNCED CHECKS
1.
Not Applicable
REASON FOR:
REPOSSESSIONS
TYPE:
Not Applicable
DP-6
REASON FOR:
/
What Steps has the applicant taken to reverse his or her negative financial history and
additionally, what is he or she doing to prevent getting into financial trouble again in the
future? Explain: (Credit Counseling?, etc.)(The typing field will expand to fit the paragraph.)
NOTES or Additional Information: the typing field expands to accommodate the needs of the user.
Page 19 of 32
UTSP EVIDENCE ORGANIZER AND REPORT OF BACKGROUND INVESTIGATION
DP-6
CRIMINAL HISTORY
Investigator Instructions: APPLICANT’S CRIMINAL HISTORY
 List and explain all undetected acts, detentions, and arrests (both custodial and non-custodial) of the applicant since
age 15. Do not include field release traffic citations.
 List and explain all incidents of the applicant being investigated as the suspect of a crime.
 List all sources checked to verify the applicant’s criminal event history record.
 For categories that require explanation, use complete sentences and thorough detail. Typing form fields expand to
accommodate the needs of the user.
 An answer must be submitted for all categories listed below. If the category is “Not Applicable” to the applicant,
note that fact as the answer to the category.
Not Applicable
Date:
/
/
EVENT #1 (Undetected acts, detentions and arrests: custodial and non-custodial)
Investigating Agency:
Charge / Nature of Event:
Disposition:
How was the event
discovered / verified?:
Applicant’s Explanation:
Not Applicable
Date:
/
EVENT #2 (Undetected acts, detentions and arrests: custodial and non-custodial)
Investigating Agency:
/
Charge / Nature of Event:
Disposition:
How was the event
discovered / verified?:
Applicant’s Explanation:
ADDITIONAL EVENT #
Not Applicable
Date:
/
Unlock the document, copy this block, and add the number of application it represents. Copy as many times as is needed
to complete the document. Re-lock the document after copying to maintain form field integrity.
/
Investigating Agency:
Charge / Nature of Event:
Disposition:
How was the event
discovered / verified?:
Applicant’s Explanation:
NOTES or Additional Information: the typing field expands to accommodate the needs of the user.
Page 20 of 32
UTSP EVIDENCE ORGANIZER AND REPORT OF BACKGROUND INVESTIGATION
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UTSP EVIDENCE ORGANIZER AND REPORT OF BACKGROUND INVESTIGATION
DP-6
CRIMINAL HISTORY – Sources to Consider
 TCIC/NCIC
 State Agencies
 University / Campus Police
 Military Police
 Municipal Police
 Child Protective Services
 County Police
 Fire Department / Arson Unit


NEXIS
Academy Applicant
attended
CRIMINAL HISTORY CHECK SOURCE #1
Name of Source:
Date of Check:
/
/
Name (if a person was contacted):
Results:
Contact Info:
# Street Address
Telephone #:
City
State
Zip
City
State
Zip
City
State
Zip
City
State
Zip
(
)
-
CRIMINAL HISTORY CHECK SOURCE #2
Name of Source:
Date of Check:
/
/
Name (if a person was contacted):
Results:
Contact Info:
# Street Address
Telephone #:
(
)
-
CRIMINAL HISTORY CHECK SOURCE #3
Name of Source:
Date of Check:
/
/
Name (if a person was contacted):
Results:
Contact Info:
# Street Address
Telephone #:
(
)
-
CRIMINAL HISTORY CHECK SOURCE #4
Name of Source:
Date of Check:
/
/
Name (if a person was contacted):
Results:
Contact Info:
# Street Address
Telephone #:
(
)
-
ADDITIONAL CRIMINAL HISTORY CHECK SOURCE #
Unlock the document, copy this block, and add the number of application it represents. Copy as many times as is needed to complete the document.
Re-lock the document after copying to maintain form field integrity.
Name of Source:
Date of Check:
/
/
Name (if a person was contacted):
Results:
Contact Info:
# Street Address
Telephone #:
City
State
Zip
(
NOTES or Additional Information: the typing field expands to accommodate the needs of the user.
Page 22 of 32
)
-
UTSP EVIDENCE ORGANIZER AND REPORT OF BACKGROUND INVESTIGATION
DP-6
CIVIL LITIGATION HISTORY
Investigator Instructions: CIVIL LITIGATION HISTORY
 List and explain all civil litigation involving the applicant since age 18. This includes all forms of civil litigation
from divorce to tort claims.
 List all sources checked to verify the applicant’s civil litigation history.
 For categories that require explanation, use complete sentences and thorough detail. The typing form fields expand
to accommodate the needs of the user.
 An answer must be submitted for all categories listed below. If the category is “Not Applicable” to the applicant,
note that fact as the answer to the category.
Not Applicable
Date:
/
/
Disposition:
Involved Parties:
CIVIL LITIGATION EVENT #1
Nature of Event:
How was this discovered / verified?
Applicant’s Explanation:
ADDITIONAL CIVIL LITIGATION EVENT #
Not Applicable
Unlock the document, copy this block, and add the number of civil litigation event it represents. Copy as many times as
is needed to complete the document. Re-lock the document after copying to maintain form field integrity.
Date:
/
/
Disposition:
Involved Parties:
Nature of Event:
How was this discovered / verified?
Applicant’s Explanation:
CIVIL LITIGATION – Sources to Consider
 County Courts
 District Courts
Not Applicable


Accurint.com
TLO.com
CIVIL LITIGATION SOURCE #1
Name of Source:
Date of Check:
/
/
Name (if a person was contacted):
Not Applicable
Results:
Contact Info:
# Street Address
Telephone #:
City
State
Zip
(
)
-
ADDITIONAL CIVIL LITIGATION SOURCE #
(Unlock the document, copy this block, and add the number of civil litigation source it represents. Copy as many times as
is needed to complete the document. Re-lock the document after copying to maintain form field integrity.
Name of Source:
Date of Check:
/
/
Name (if a person was contacted):
Results:
Contact Info:
# Street Address
Telephone #:
City
Page 23 of 32
State
Zip
(
)
-
UTSP EVIDENCE ORGANIZER AND REPORT OF BACKGROUND INVESTIGATION
NOTES or Additional Information: the typing field expands to accommodate the needs of the user.
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UTSP EVIDENCE ORGANIZER AND REPORT OF BACKGROUND INVESTIGATION
DP-6
TRAFFIC RECORD
Investigator Instructions: TRAFFIC RECORD
 List all traffic citations and accidents involving the applicant over the last 7 years, excluding parking tickets.
 List all sources checked to verify the applicant’s traffic history.
 For categories that require explanation, use complete sentences and thorough detail. Typing form fields expand to
accommodate the needs of the user.
 An answer must be submitted for all categories listed below. If the category is “Not Applicable” to the applicant,
note that fact as the answer to the category.
Not Applicable
Event Date:
/
TRAFFIC EVENT #1
/
Investigating Agency:
Charge / Nature:
Disposition:
How was this discovered / Verified?
Other:
Not Applicable
Event Date:
/
TRAFFIC EVENT #2
/
Investigating Agency:
Charge / Nature:
Disposition:
How was this discovered / Verified?
Other:
ADDITIONAL TRAFFIC EVENT #
(Unlock the document, copy this block, and add the number of traffic event it represents. Copy as many times as is
Not Applicable
needed to complete the document. Re-lock the document after copying to maintain form field integrity.
Event Date:
/
/
Investigating Agency:
Charge / Nature:
Disposition:
How was this discovered / Verified?
Other:
TRAFFIC HISTORY – Sources to Consider
 Municipal Police
 County Police
 Insurance Carriers
 Court Records
TRAFFIC HISTORY CHECK SOURCE #1
Name of Source:
Page 25 of 32


State Police
Other
UTSP EVIDENCE ORGANIZER AND REPORT OF BACKGROUND INVESTIGATION
Date of Check:
/
/
Name (if a person was contacted):
DP-6
Results:
Contact Info:
# Street Address
Telephone #:
City
State
Zip
City
State
Zip
City
State
Zip
City
State
Zip
(
)
-
TRAFFIC HISTORY CHECK SOURCE #2
Name of Source:
Date of Check:
/
/
Name (if a person was contacted):
Results:
Contact Info:
# Street Address
Telephone #:
(
)
-
TRAFFIC HISTORY CHECK SOURCE #3
Name of Source:
Date of Check:
/
/
Name (if a person was contacted):
Results:
Contact Info:
# Street Address
Telephone #:
(
)
-
TRAFFIC HISTORY CHECK SOURCE #4
Name of Source:
Date of Check:
/
/
Name (if a person was contacted):
Results:
Contact Info:
# Street Address
Telephone #:
(
)
-
ADDITIONAL TRAFFIC HISTORY CHECK SOURCE #
Unlock the document, copy this block, and add the number of application it represents. Copy as many times as is needed to complete the document.
Re-lock the document after copying to maintain form field integrity.
Name of Source:
Date of Check:
/
/
Name (if a person was contacted):
Results:
Contact Info:
# Street Address
Telephone #:
City
State
Zip
(
NOTES or Additional Information: the typing field expands to accommodate the needs of the user.
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)
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UTSP EVIDENCE ORGANIZER AND REPORT OF BACKGROUND INVESTIGATION
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PERSONAL AND EMOTIONAL HISTORY
Investigator Instructions: APPLICANT’S PERSONALITY AND EMOTIONAL HISTORY
 Describe the applicant’s personality suitability and emotional fitness for the position sought.
 For categories that require explanation, use complete sentences and thorough detail. The typing form fields will
expand to accommodate the needs of the user.
 An answer must be submitted for all categories listed below. If the category is “Not Applicable” to the applicant,
note that fact as the answer to the category.
PERSONALITY TRAITS: (Use examples to describe the applicant’s personality traits. Use complete sentences and thorough detail.)
Dependability:
Initiative:
Interpersonal Skills:
Integrity:
Self-Control:
Situational Reasoning:
Not Applicable
HISTORY OF EMOTIONAL PROBLEMS
List any emotional, personal Judgment, or other issues relevant to employment:
NOTES or Additional Information: the typing field expands to accommodate the needs of the user.
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UTSP EVIDENCE ORGANIZER AND REPORT OF BACKGROUND INVESTIGATION
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HISTORY OF NARCOTICS AND CONTROLLED SUBSTANCES
Investigator Instructions: APPLICANT’S USE OF NARCOTICS AND CONTROLLED SUBSTANCES
 Describe the applicant’s use of narcotics and controlled substances for the position sought.
 For categories that require explanation, use complete sentences and thorough detail. The typing form fields will
expand to accommodate the needs of the user.
 An answer must be submitted for all categories listed below. If the category is “Not Applicable” to the applicant,
note that fact as the answer to the category.
Not Applicable
Any Evidence of involvement in the purchase, sale, cultivation or transport of narcotics?
The form field will expand to accommodate the needs of the user. Explain:
Not Applicable
Type of Narcotic/Controlled Substance # 1
Frequency:
Last time used:
Typical circumstances surrounding usage:
Not Applicable
Type of Narcotic/Controlled Substance # 2
Frequency:
Last time used:
Typical circumstances surrounding usage:
Not Applicable
Type of Narcotic/Controlled Substance # 3
Frequency:
Last time used:
Typical circumstances surrounding usage:
Not Applicable
ADDITIONAL: Type of Narcotic/Controlled Substance #
Unlock the document, copy this block, and add the number of bounced check it represents. Copy as many times as is
needed to complete the document. Re-lock the document after copying to maintain form field integrity.
Frequency:
Last time used:
Typical circumstances surrounding usage:
NOTES or Additional Information: the typing field expands to accommodate the needs of the user.
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UTSP EVIDENCE ORGANIZER AND REPORT OF BACKGROUND INVESTIGATION
DP-6
HISTORY OF ALCOHOL USE
Investigator Instructions: APPLICANT’S HISTORY OF ALCOHOL USE
 Describe the applicant’s use of alcohol for the position sought.
 For categories that require explanation, use complete sentences and thorough detail. The typing form fields will
expand to accommodate the needs of the user.
 An answer must be submitted for all categories listed below. If the category is “Not Applicable” to the applicant,
note that fact as the answer to the category.
Not Applicable
HISTORY OF ALCOHOL USE
TYPES OF ALCOHOL:
Beer
Wine
Mixed Drinks (Whiskey, Brandy, Rum, Vodka, Etc.)
Last time used:
Frequency Used:
Typical Circumstances surrounding use:
Is there evidence of a drinking problem?
Yes
No
Explain:
Effect of drinking on:
Work Performance
Relations with Others
Family Finances
Judgment
Physical Condition
NOTES or Additional Information: the typing field expands to accommodate the needs of the user.
Page 29 of 32
UTSP EVIDENCE ORGANIZER AND REPORT OF BACKGROUND INVESTIGATION
DP-6
MEMBERSHIPS IN GROUPS, ASSOCIATIONS OR CLUBS
Investigator Instructions: APPLICANT’S MEMBERSHIPS IN GROUPS ASSOCIATIONS OR CLUBS
 Describe the applicant’s membership in groups, associations or clubs for the position sought.
 For categories that require explanation, use complete sentences and thorough detail. The typing form fields will
expand to accommodate the needs of the user.
 An answer must be submitted for all categories listed below. If the category is “Not Applicable” to the applicant,
note that fact as the answer to the category.
Not Applicable
NAME OF ORGANIZATION #1
What is the general purpose of the organization?
How active is the applicant in the organization?
Applicant’s reasons or motives for joining?
Applicant’s reputation within the organization?
Not Applicable
NAME OF ORGANIZATION #2
What is the general purpose of the organization?
How active is the applicant in the organization?
Applicant’s reasons or motives for joining?
Applicant’s reputation within the organization?
Not Applicable
NAME OF ORGANIZATION #3
What is the general purpose of the organization?
How active is the applicant in the organization?
Applicant’s reasons or motives for joining?
Applicant’s reputation within the organization?
NOTES or Additional Information: the typing field expands to accommodate the needs of the user.
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UTSP EVIDENCE ORGANIZER AND REPORT OF BACKGROUND INVESTIGATION
DP-6
SOCIAL MEDIA
APPLICANT’S SOCIAL MEDIA ACTIVITY
Does the applicant have social networking, instant messaging, blogs or other internet-based profiles?
If so, provide screen name(s) and service provider(s):
Results of social network, instant messaging, blogs, or other internet-based profile search:
(Content referring to applicant’s maturity or reputation)
Results of web search of the applicant (news articles, blogs, comments posted on websites, etc):
NOTES or Additional Information: the typing field expands to accommodate the needs of the user.
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Yes
No
UTSP EVIDENCE ORGANIZER AND REPORT OF BACKGROUND INVESTIGATION
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DP-6