CITY OF HARTFORD

HARTFORD POLICE DEPARTMENT

50 Jennings Road
Hartford, Connecticut 06120
Telephone: (860) 757-4000
EDDIE A. PEREZ Fax: (860)722-8270 DARYLK. ROBERTS
Mayor www.hartford.gov Chief of Police

QUESTIONS REGARDING CONVICTIONS

(Question must be completed)

Please note the following definitions that relate to your response to this question.

"Conviction", for the purpose of this application, means a final judgment or verdict of guilty, a
plea of guilty, or a plea of nolo contendefe, in any state or federal court, regardless of whether an
appeal is pending or could be taken.

"Conviction", for the purpose of this application, does not include a final judgment or verdict
that has been expunged by pardon, reversed, set aside or otherwise rendered invalid. Further,
you are not required to disclose any arrestfs), criminal chargcs(s) or convictionfs) the
recordis) of which have been erased under law. Such records can include records of a finding
of delinquency or that a child was a member of a family with service needs, adjudication of
youthful offender status, criminal charges dismissed or nolled, or charges for which a person is
found not guilty or a conviction later resulting in an absolute pardon.

Further, any person whose criminal records have been erased is deemed under law never to have
been arrested with respect to such erased proceedings and may so swear under oath.

A history of criminal conviction(s) will not necessarily bar consideration of employment-

Factors such as the time, seriousness and nature of the offense, rehabilitation, as well as the
nature of the position for which you are applying, will be taken into account.

Should you have any questions about answering questions on this application, or your rights
concerning erased records, please contact the Personnel Department.

Have you ever been convicted of a crime? D No Yes

If yes, please explain.
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Date

Date

Position for which you are Applying

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Background Investigation Unit

 I HARTFORD POLICE DEPARTMENT
Background Investigation Unit

DETECTIVE BUREAU
Det. Frances DuBose Watson

Candidate: Biffle, Henry

The following information reported to the Fire Department on or about

4/07/08:

• Candidate has Charges of Assault Third and Threatening- 2nd during 1996

Sentenced to probation 1 year suspended, 1-3- years probation

> Candidate has a charge of Violation of Protective Order during 1997

Sentenced to Probation 1 year suspended, 1-3 year's probation.

• He had no MA/ Violations as of 4/07/08

 CITY OF HARTFORD
HARTFORD POLICE DEPARTMENT
50 Jennings Road
Hartford, Connecticut 06120
Telephone: (860) 757-4000
EDDIE A. PEREZ Fax: (860)722-8270 DARYL K. ROBERTS
Mayor www.hartford.gov Chief of Police

Background Investigation Unit

CIVILIAN APPLICANT AFFIDAVIT

Mnuncc [Applicant's Name Printed]

, certify

that the personal history form (Background Investigation Questionnaire) contains no

MISREPRESENTATIONS, FALSIFICATIONS, OMISSIONS, or CONCEALMENTS
material fact and that the information given by me is completed to the best of my
knowledge and belief. I am aware that all statements made by me on the personal history
form are subject to later investigation.

I am further aware that should any investigation disclose ANY misrepresentations,

falsifications, omissions, or concealment of any material fact, either on the personal history
form or during any other stage of the background investigation, my application may be
rejected and my name may be removed from eligibility. I will also be disqualified from
applying in the future for any position in the service of the City of Hartford.

Applicant's Signature

tf
Subscribed and sworn before me, this ¥ day
My
of February 28, 20! 0

Notary's Signature:
*~^C^
Official Raised Stamp

Background Investigation Unit