The Maryland Polygraph Police Form, commonly referred to as the MSP 40-23, is a comprehensive document required to be filled out by applicants seeking employment with the Maryland State Police, including positions ranging from Trooper and Cadet to Civilian and Allied Agency roles. It serves as a preliminary step in the pre-employment screening process, mandating the completion of a polygraph examination to assess the truthfulness of the applicant's provided information in various sections, including personal background, citizenship, and residency. For individuals pursuing a career with the Maryland State Police, it is crucial to carefully complete and submit this form with accuracy and honesty. To move forward in your application process, please ensure to fill out the Maryland Polygraph Police Form by clicking the button below.
When considering employment with the Maryland State Police, applicants are introduced to a thorough and meticulous pre-employment process, which includes completing the Maryland Polygraph Police form. This form is a significant component of the Applicant Polygraph Screening Booklet, designed to assess candidates’ suitability for positions such as Trooper, Cadet, Civilian, or other roles within the agency. Upon receiving a written Conditional Offer of Employment, applicants are required to undergo a polygraph examination—a step emphasizing the importance of integrity and honesty for prospective employees. The form serves as a comprehensive tool for collecting personal background information, including identity, residency, and citizenship details, aiming to verify the truthfulness and completeness of information provided by the applicants. It delves into various aspects of a candidate's background, probing into matters like name changes, use of false identification, and past residency issues, among others. Furthermore, applicants are asked to disclose any affiliations with foreign governments or intelligence agencies, underlining the depth of scrutiny to ensure that individuals entering the Maryland State Police hold the highest standards of loyalty and ethical conduct. The process is encapsulated with an agreement to release the Maryland State Police, its officers, employees, and agents from liability arising from the polygraph examination, highlighting the examination's gravity and the accountability expected from applicants.
Assigned to: _____________________
Tracking 67# ____________________
MARYLAND STATE POLICE APPLICANT POLYGRAPH SCREENING BOOKLET
Position Applied For:
Trooper Cadet
Civilian
Allied Agency
Other_
Have you received a written Conditional Offer of Employment? Yes No
INSTRUCTIONS TO APPLICANT:
You are being considered for employment with the Maryland State Police. As a prerequisite for employment, you are required to submit to a pre-employment polygraph examination. As part of that process, it will be necessary for you to complete this booklet. The contents of this booklet are held "CONFIDENTIAL," except when essential to the conduct of proper official police business and national security. It is important that you understand that the intentional misrepresentation, omission, or falsification of any material fact may be just cause for disqualification or dismissal from the applicant process.
Maryland State Police employees, regardless of position, are placed in a position of trust and responsibility. Because of this trust, the MSP expects candor and honesty from all employees. The purpose of this examination is to determine the truthfulness of the information provided to the polygraph examiner. The areas of inquiry will deal with your background and experience.
During the interview with the polygraph examiner, you will discuss many aspects of your background. Some may seem so "bad" that you are afraid it will disqualify you from this job. What will disqualify you is your failure to provide truthful, accurate, and complete information.
The next page is your written permission for the examiner to administer your examination. Do not mark on the page except to sign it in the lower right corner marked "signature."
Name (Last, First Middle) ________________________________________________________
Date of Birth_____________ Driver's License Number / State ____________________________
Mailing Address _______________________________________________________________
City ________________ County ______________ State __________ Zip Code ___________
Telephone: Home________________ Work _______________Cell Phone ________________
E-mail address ________________________________________________________________
Current Employer ______________________________________________________________
Employment Address ___________________________________________________________
Date Booklet Completed: ___________________
MSP 40-23 (05-17)
1
RELEASE
I hereby voluntarily submit to a polygraph examination (detection of deception) by the Maryland State Police. I understand and agree that the polygraph examination will be audio and video recorded and that the recordings as well as the results of the polygraph examination may be made available to the proper authorities, including but not limited to other law enforcement agencies, social service agencies and current or past employers. In consideration of being given a polygraph examination without cost to me, I, for myself, my heirs, personal representatives and assigns, hereby agree to hold harmless, the Maryland State Police, its officers, employees, and agents from any liability for any damage to me as a result of said examination and I hereby remise, release, waive, and forever discharge and exonerate said Maryland State Police, its officers, employees, agents from any and all action or cause of action, claim, or demand which I have now or may ever have resulting directly, indirectly, or remotely from said examination or making known any reactions, statements, information, and incidental opinions made by me as part of the examination.
In witness whereof, I have hereunto set my hand and seal the day and date set forth above.
_________________________________
____________________________
WITNESS
SIGNATURE / DATE
2
SECTION A: PERSONAL BACKGROUND INFORMATION
PART 1: IDENTITY
Full Name: (Last, First Middle):____________________________________________________________________
Date of Birth: _________________ Race:________ Gender:_________ Place of Birth: _____________________
Social Security Number: _________________________________________________________________________
Scars, marks, or tattoos: (explain any significance) ____________________________________________________
_____________________________________________________________________________________________
Excluding nicknames, list any other names you have ever used and the periods of time you used them:
_________________________________________________________________________________________________
YES NO
1.
2.
3.
4.
5.
6.
7.
8.
9.
Has your name ever been changed by court order?
Have you ever used a false name, date of birth, or place of birth for any reason? Have you ever obtained, possessed, or used any form of false identification? Have you ever used a false Social Security Number or someone else’s SSN? Have you ever misrepresented your identity to any law enforcement agency? Have you ever falsified your identity on any job application?
Have you ever falsified your identity on any credit application?
Have you ever falsified your identity on any other application or official document?
While underage, did you ever use any type of false identification to buy alcoholic beverages?
WRITTEN EXPLANATIONS FOR ANY “YES” ANSWERS TO SECTION A, PART 1 - IDENTITY:
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SECTION A: PERSONAL BACKGROUND INFORMATION (Continued)
PART 2: CITIZENSHIP
____ ____ Have you ever held citizenship in any country other than the United States?
IF YOU ANSWERED “YES” TO THE ABOVE QUESTION, YOU MUST ALSO ANSWER THE BELOW QUESTIONS ON THIS PAGE. IF YOU ANSWERED “NO” TO THE ABOVE QUESTION, YOU DO NOT HAVE TO ANSWER THE BELOW QUESTIONS ON THIS PAGE. PROCEED TO SECTION A, Part 3 (page 6).
Excluding the United States, list all foreign countries where you have held citizenship and the periods of time for each:
In what country were you born?________________________________________________________________________
At what age did you leave your country of birth? _________ At what age did you come to the U.S.?_______
Why did you leave your country of birth?_________________________________________________________________
Why did you come to the U.S.?________________________________________________________________________
With whom did you come to the U.S.?___________________________________________________________________
To what country do you hold your primary allegiance (loyalty)? _______________________________________________
Have you ever worked for a foreign government or foreign law enforcement agency? Have you ever been a member of a foreign military service?
Have you ever worked for, or been affiliated in any way, with a foreign intelligence agency? Are you now a Naturalized United States Citizen?
Have you provided this department with a valid Naturalization Certificate? Do you possess a valid passport issued by a foreign country?
Have you taken part in committing any crime(s) in another country?
WRITTEN EXPLANATIONS FOR ANY “YES” ANSWERS TO SECTION A, PART 2 – CITIZENSHIP:
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PART 3: RESIDENCY
List your current home address: _______________________________________________________________________
List any other addresses where you stay on a regular basis: _________________________________________________
YES
NO
Have you ever been evicted or threatened with eviction from any places you have lived?
Have you ever had a mortgage foreclosure taken against you?
Excluding eviction or foreclosure, have you ever been ordered to vacate any place you have lived?
Have you ever been forced to vacate housing at any colleges due to disciplinary problems?
Have you ever received a notice to appear in Landlord-Tenant Court?
Do you reside at any other address on a regular basis?
____
Have you ever broken a lease at any place you lived?
Have any liens been placed against any property you have owned?
Have you had any police contact while leasing or renting?
10.
Have you been involved in any arguments or fights with any of your neighbors?
11.
Will any of your current or former neighbors say anything derogatory about you?
12.
Have you ever moved out of any place you have lived due to arguments or disputes with your spouse,
family members, roommates, neighbors, or landlords?
WRITTEN EXPLANATIONS FOR ANY “YES” ANSWERS TO SECTION A, PART 3 - RESIDENCY:
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PART 4: EDUCATION
Name of High School Attended: ________________________________ Dates Attended: ______________________
Address: ______________________________________________________ Diploma Received: Yes
No
Highest Grade Completed: ______ Graduation Date: __________ High School Equivalency (GED): Yes
COLLEGES / UNIVERSITIES ATTENDED (Include name, address, # of credit hours, major, degree received)
13.
14.
15.
Were you ever suspended or expelled from any type of learning establishment for any reason? Did you ever have any adverse contact with high school security or school police?
Were you ever taken into custody or charged with any crimes by high school security or police? Did you ever have any adverse contact with college campus security or college police?
Were you ever taken into custody or charged with any crimes by campus security or police? Were you ever questioned as a suspect in any crimes by campus security or police?
Were you ever ineligible to return to any high school or college due to disciplinary reasons? Were you ever barred from entering the property of any high school or college?
Did you ever have any adverse contact with any resident assistants?
Were you ever required to appear before any college hearing board as a result of disciplinary action? Did you ever cheat on any exams, tests, assignments, projects, or papers in high school or college? Were you ever caught cheating in any educational or training environment?
Did you ever falsify your high school or college grades or grade point average? Did you ever falsify any information on your high school or college transcripts? Did you ever have any academic/disciplinary probations in high school or college?
WRITTEN EXPLANATIONS FOR ANY “YES” ANSWERS TO SECTION A, PART 4 - EDUCATION:
6
PART 5: EMPLOYMENT
Please list places of employment starting from most recent. Also include dates employed. (If needed, use additional space provided in the remark sections)
16.
17.
18.
19.
20.
_
Have you ever been fired from any job?
Have you ever been allowed to resign from any job in place of being fired?
Have you ever quit any job because you thought you were going to get fired?
Are you ineligible for rehire at any place of employment now?
Have you ever been denied any merit increases due to poor performance evaluations?
Have you ever been involved in any physical or verbal confrontation with any coworker, supervisor,
or customer?
Have you ever quit any job due to allegations of misconduct on your part?
Have you ever received any written disciplinary action on any jobs?
Have you ever been suspended (with or without pay) from any job?
Have you ever been investigated for any criminal acts against any of your employers?
Have you ever been involved in industrial or corporate espionage?
Have you ever committed any criminal acts against any of your employers or coworkers?
Have you ever deliberately violated any serious employment rules or regulations?
Have you ever deliberately violated any employment nondisclosure agreements?
Have you ever been denied employment due to adverse results of a background investigation?
Have you ever applied to any police department or law enforcement agency?
Have you ever been employed by any police department or other law enforcement agency?
Have you ever been rejected for employment by any police department or law enforcement agency?
Have you ever had any prior polygraph examination? If “Yes”, list when, where, and results.
Have you ever before made application for employment with the Maryland State Police? If yes, when,
what position, and what is the status of that application.
WRITTEN EXPLANATIONS FOR ANY “YES” ANSWERS TO SECTION A, PART 5 - EMPLOYMENT:
7
PART 6: FINANCES / CREDIT / LAWSUITS
Have you ever declared bankruptcy?
Have any court ordered financial judgments ever been taken against you? Have you ever had any property repossessed?
Have you ever had any accounts taken over by a collection agency? Are any of your current debts or bills 30 or more days delinquent? Have any liens been placed against any property you have owned?
Have you ever been sanctioned by the IRS or any state income tax agency? Do you have any alimony or child support obligations?
IF YOU ANSWERED “YES” TO ANY OF THE ABOVE QUESTIONS, STATE WHAT SPECIFIC ACTIONS YOU TOOK OR ARE NOW TAKING TO RESOLVE THESE FINANCIAL PROBLEMS.
Have your wages ever been garnished?
Has anyone ever sued you?
Have you ever sued anyone?
Have you ever received any out of court settlements?
Have any of your bank accounts ever been garnished or frozen?
WRITTEN EXPLANATIONS FOR ANY “YES” ANSWERS TO SECTION A, PART 6 - FINANCES / CREDIT / LAWSUITS:
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PART 7: MILITARY SERVICE
Have you ever served in any branch of the Unites States military? Have you ever been rejected by any branch of the military?
Have you ever served in, or attempted to enlist in, any branch of a foreign military? Have you registered for selective service?
IF YOU SERVED IN THE MILITARY (U.S. OR FOREIGN) YOU MUST ALSO ANSWER THE FOLLOWING QUESTIONS. IF YOU HAVE NOT SERVED IN THE MILITARY, YOU DO NOT HAVE TO ANSWER THE BELOW QUESTIONS AND CAN NOW PROCEED TO SECTION 8.
Did you receive an Honorable Discharge? (IF NO, EXPLAIN)
Were you ever court-martialed?
Did you ever receive any nonjudicial punishments (written or verbal reprimand, etc.)? Were you ever questioned as a suspect in any crimes by any U.S. or foreign military police? Did you ever have any adverse contact with any U.S. or foreign police?
Were you ever denied eligibility for re-enlistment?
Were you ever charged with any violations of the Uniform Code of Military Justice (UCMJ)? Have you ever altered a copy of your DD-214 during any pre-employment investigation?
WRITTEN EXPLANATIONS FOR ANY “YES” ANSWERS TO SECTION A, PART 7 - MILITARY SERVICE:
9
PART 8: DRIVER’S LICENSE / RECORD / ACCIDENTS
Have you ever operated a vehicle after consuming any intoxicating substance to the point of impairment?
Have you ever operated a vehicle after consuming any intoxicating substance to the point of intoxication?
Have you ever fled from, or attempted to elude, police while on foot or in a vehicle? Have you ever operated a motor vehicle knowing it was uninsured / unregistered? Have your license plates ever been confiscated by the police or MVA?
Has your vehicle insurance ever been canceled or denied renewal? Have you ever failed to appear in court as a result of any traffic ticket? Have you ever received any traffic tickets as a result of a traffic accident? Have you ever been involved in any law-suit as a result of a traffic accident? Have you ever been involved in a hit and run accident?
Have you ever lied to any police officers to try to get out of a traffic ticket?
Have you ever lied to a judge in traffic court?
Do you currently have any traffic or parking tickets for which you have not paid the fine or appeared in court for?
Have you ever had a driver’s license in any other state? If so, list the periods of time for each? Have you ever filed to have any violations expunged from your driving record? If so, explain.
List below all traffic stops in this state or any other state that resulted in you receiving any of the following: citations, written warnings, verbal warnings, Safety Equipment Repair Orders, red light tickets, speed camera tickets.
DATE
STATE
VIOLATION(S)
DISPOSITION
10
When preparing to join the Maryland State Police, candidates undergo a comprehensive evaluation process, part of which includes a polygraph screening. This pre-employment polygraph examination is crucial for assessing the honesty and integrity of potential employees. To facilitate this process efficiently, applicants are required to fill out a detailed booklet that collects extensive personal and background information. This form serves a pivotal role in ensuring the truthfulness of the information provided by candidates. It's important for applicants to approach this task with the utmost sincerity, understanding that the accuracy and completeness of their responses will significantly impact their consideration for employment.
To complete the Maryland Polygraph Police Form, follow the steps below:
Once the form is fully completed, review your information carefully to ensure accuracy and completeness. Submit the form as per the instructions provided by the Maryland State Police. Remember, honesty and thoroughness in your responses are critical for the assessment process and can significantly influence your eligibility for the positions applied for.
The Maryland State Police Applicant Polygraph Screening Booklet is designed as a comprehensive pre-employment screening tool. Its primary purpose is to facilitate the polygraph examination component of the hiring process for various positions within the Maryland State Police, including Trooper, Cadet, Civilian, and Allied Agency roles. This booklet serves as a means for applicants to provide personal and background information, which is later scrutinized under a polygraph examination to verify the truthfulness of the applicant. This process is vital for ensuring the integrity and reliability of potential employees who, if hired, will be placed in positions of trust and responsibility. The booklet includes a warning that intentional misrepresentation or omission of material facts may lead to disqualification or dismissal from the application process.
In the booklet, applicants are required to provide a wide range of personal information encompassing various aspects of their identity, background, and experience. This includes but is not limited to:
Yes, the information provided by applicants in the Maryland State Police Applicant Polygraph Screening Booklet is held "CONFIDENTIAL.” It is protected and only disclosed when necessary for official police business and national security purposes. However, applicants should be aware that as part of the polygraph examination process, both the information provided in the booklet and the results of the polygraph test itself may be shared with the proper authorities as deemed necessary for the evaluation of the applicant's suitability for the position applied for.
Intentional misrepresentation, omission, or falsification of any material fact within the booklet is considered a serious offense and may result in immediate disqualification or dismissal from the applicant process. The Maryland State Police emphasize the importance of candor and honesty from their employees due to the trust and responsibility placed in their positions. Failure to provide truthful, accurate, and complete information during any stage of the hiring process, including within this booklet, undermines the integrity of the application process and is grounds for disqualification or termination of employment if discovered after hiring.
The polygraph examination is a critical component of the Maryland State Police's pre-employment screening process. After submitting the completed booklet, applicants undergo a polygraph test where the information provided in the booklet is verified for truthfulness. This examination allows examiners to assess the integrity and honesty of applicants by asking them direct questions about their background, experiences, and the responses provided in the booklet. The outcomes of this test play a significant role in determining an applicant's eligibility for employment. Successful passage of the polygraph examination is necessary for moving forward in the application process, as it demonstrates the applicant's honesty and suitability for a position of trust within the Maryland State Police.
When completing the Maryland State Police Applicant Polygraph Screening Booklet, individuals often encounter several pitfalls that could affect their candidacy for employment. Understanding these common mistakes can significantly enhance one's ability to provide accurate and complete information, adhering to the requisites of the process. Here are nine common errors to be aware of:
It's critical for applicants to approach this booklet with the seriousness it demands. Below are additional tips to ensure a more successful completion:
In summary, the preparation and completion of the Maryland State Police Applicant Polygraph Screening Booklet require a thoughtful and truthful approach. By avoiding common mistakes and adhering to the guidelines provided, applicants can better navigate this critical step in the hiring process.
When applying for a position within the Maryland State Police, candidates are not only required to complete the Maryland Polygraph Police Form but may also need to submit additional documents and forms throughout the application process. These supplementary forms and documents play a crucial role in providing a comprehensive profile of the applicant, ensuring a thorough evaluation process. Below is a list of documents often used alongside the Maryland Polygraph Police Form, each described briefly:
Each of these documents serves as an integral part of the holistic review and evaluation of a candidate’s suitability for employment with the Maryland State Police. It is vital for applicants to understand the importance of each form or document they are required to submit, ensuring accuracy and completeness to facilitate a smooth and effective hiring process.
The Maryland Polygraph Police form is similar to various other documents used within law enforcement and governmental hiring processes, specifically in its structure and the type of information it collects. For instance, documents utilized by the Federal Bureau of Investigations (FBI) for candidates undergoing background checks bear resemblance in both content and intent.
Similar to the Maryland Polygraph Police form, FBI background check forms require detailed personal information, previous employment history, and any past interactions with law enforcement. Both forms share a common goal: assessing an individual’s suitability for a position of trust and responsibility. They emphasize the need for honesty and the consequences of providing false information, highlighting the importance of integrity in the hiring process. Each document includes sections that require the applicant to disclose potential criminal history, past use of aliases or different social security numbers, and citizenship status. This parallel underscores the thorough and comprehensive nature of background checks in law enforcement and related fields.
Another document that shares similarities with the Maryland Polygraph Police form is the Security Clearance application used by the Department of Defense (DoD) for military and civilian positions requiring access to classified information. Like the Maryland form, the DoD Security Clearance application delves into an applicant's personal history, including foreign travel, family background, and any instances of financial delinquency. Both documents serve a critical function in safeguarding sensitive information and ensuring that only individuals of the highest integrity and reliability are selected for positions that could influence the safety and security of the nation. The emphasis on disclosing information related to citizenship, foreign contacts, or allegiances is particularly pronounced in both forms, reflecting the crucial role of trustworthiness in national security environments.
When completing the Maryland State Police Applicant Polygraph Screening Booklet, it's crucial to approach the process thoughtfully and accurately. Here are some do's and don'ts to guide you through filling out the form:
Following these guidelines will help ensure that your application is completed accurately and reflects your qualifications and honesty. Remember, the goal is to provide the Maryland State Police with the information they need to effectively evaluate your suitability for the position you're applying for.
There are many misconceptions about the Maryland Polygraph Police form used in the process of applying for positions with the Maryland State Police. It's important to clarify these misunderstandings to provide accurate information to potential applicants.
Only criminal history matters: Many believe that the polygraph only screens for criminal behavior. However, the form clearly indicates that questions also cover personal background, citizenship, and residency, not just criminal history.
The process lacks confidentiality: Applicants might fear that their information could be shared widely. Yet, the booklet specifies that contents are held "CONFIDENTIAL" and are only disclosed when essential for official police business or national security.
Minor misdeeds will disqualify you: There's a misconception that any past misstep will automatically disqualify an applicant. The form emphasizes honesty, and it's the failure to provide truthful information that is most likely to disqualify someone.
There's a cost to the applicant: Some might wrongly assume they have to pay for the polygraph test. The form states the examination is conducted without cost to the applicant.
Falsifying information only pertains to criminal acts: It's mistakenly thought that only criminal information falsified affects your application. The form asks about falsification in a broad sense, including employment and credit applications.
Only current U.S. citizens can apply: The detailed questions about citizenship might lead some to believe that only current U.S. citizens can apply. However, the form is designed to gather comprehensive background information, including details on naturalization and foreign citizenship, suggesting that non-citizens can also be considered.
Previous employment isn't important: Despite focusing much on criminal background and personal conduct, the form underlines the significance of accurate employment history, indicating that previous employment is, indeed, an important factor.
You can't discuss any "bad" elements in your background: The form clarifies that discussing aspects of your background that may seem unfavorable will not necessarily disqualify you, but lying about them will. This corrects the misconception that you're better off not disclosing them at all.
The form only serves to eliminate candidates: While it's a screening tool, the primary purpose of the form and the polygraph examination is to verify the truthfulness of the information provided, not merely to disqualify applicants.
All personal information is left unexplained: The form provides space for written explanations for any "yes" responses in various sections, allowing applicants to clarify circumstances that might otherwise be misunderstood.
Understanding these points helps clarify the purpose and process of the Maryland Polygraph Police form, ensuring that potential applicants have accurate information and can approach the application process more confidently.
Filling out the Maryland Polygraph Police form is a crucial step in the application process for various positions within the Maryland State Police (MSP), including Trooper, Cadet, Civilian, and Allied Agency positions. Understanding the key elements can help ensure a smooth procedure. Here are seven important takeaways:
Applicants are encouraged to approach the completion of this form and the subsequent polygraph test with honesty, as the main objective is to affirm the integrity and reliability of potential future Maryland State Police employees.
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