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    Cleveland Police Officer Adrian Calhoun on the personnel file

    Copyright:

    © All Rights Reserved
    Download as PDF or read online from Scribd
    Flag for inappropriate content
    623 views49 pages

    CPO Adrian Calhoun Personnel File

    Uploaded by

    WKYC.com
    Cleveland Police Officer Adrian Calhoun on the personnel file

    Copyright:

    © All Rights Reserved
    Download as PDF or read online from Scribd
    Flag for inappropriate content
    of 49
    Adrian Calhoun Dept. of Human Resources Personnel File ity of Cleveland Memorandum rank kan Mor Social Security Numbers andr Federal Identification Numbers have been redacted Under State ex rel. Beacon Joumal Publishing Co. v. Akron (1970), 70 Ohio St.34 605. “The employee's house number and street name have been redacted under State ox ‘al, Dispatch Printing Co. v. Johnson (2005), 106 Ohio St.3d 160. “The employee's day and month of birth and personal telephone numbers have been redacted because they are not records under O.R.C, 149.011(G) and 149.43 Personal information, including medical recorés, regarding safety personnel is exempt from public records felease under Ohio Revised Code 149.43 and The STATE ex rel PLAIN DEALER PUBLISHING COMPANY v. CITY OF CLEVELAND, 106 Ohio St.3d 70, 2005. In defining what is a public record O.R.C. §149.43(A)(1(6) exempts Peace Orficer familial information as Fallows: (1) "Public record” means records kept by any public office, Including, bat rot limited to, state, county, city, vilage, township, and schoo! district units, and’ records pertaining to the dalvery of educational services by an alternative schoo! in this state kept by the nonprofit or for profit entity operating the alternative school pursuant to section '3313.533 of the Revised Code. "Public record” does not mean any of the following (p) Peace officer, parole officer, prosecuting attorney, assistant prosecuting attorney, corectional employee, youth services employes, firefighter, or EMT residential and familial information; O.R.C. $149.43 (AX7)(Q) further cares by stating that Peace Officer Includes firefighter and EMT, and exempts from public records photographs of Peace Officers Who are or may have undercover or plain clathes assignments as determined by the appointing authority. That section reads as follows: (7) "Peace officer, parole officer, prosecuting attorney, assistant prosecuting attorney, correctional employee, youth services employee, Frefighter, or EMT residential and familial Information” means any information that discloses any of the folowing about peace officer, parole officer, prosecuting attomey, assistant prosecuting attorney, correctional employee, youth services employee, firefighter, or EMT: *(@) A photograph of a peace officer who holds @ position or has an assignment that may include undercover or plain dothes postions or assignments as determined by the peace offce’s appointing author.” Ege Opertaiy Epon ‘hy of Cleveland Department of Human Resources Orientation checklist Employee Orientation Human Resources Department (21664-2499 Name of employes ATI ne Coivorn Dept Quel segs Date WDSN>_ This hackles tobe campleted bythe new erpayee a New Hie Orentation Teg. €2ch tem we ‘suse dtaltnoneraton bythe Human Resources Falitatr. When the cess capeted each ne Employee an Human Resources actatristo sgn an the frm wl Be qlaedin te employee's permanent ‘New Hire Orientation Binder Includes: > Nien Hire Packet > Medes Benes Summary ude > Rouble Suing Account Fors > Manor Tanne Courer > ‘donal Employ Forms Welcome! Trang objective ‘ur cy/Our ayo ‘ky of leva Mision Statement Performance and Expectations (Ou Core Vales) Mandatory Tangs 1 Wurman Resources Poly and Procedures Manval Overview 1 Secon A Holy, Vacation and Sek Poi Secon & Probation Prod 1 Seon € Artendance oly, Erland intr, Personal lecranc Deis, Progressive Dine Sensal Horasment Poly, WorgaceOess Code Onin nvliment Medial Choses Elie nsrance Fel Sein Account forms IN. ChSenvces Commision 1 What eCullserices Testing 1G Serves Rules ad Regul V._OPERS and Deere Comp overaw 2 OFKS Deferred compensation VL Mandatory Taning courses 12 Org fre Wrkpace 12 Violence inthe Workace = Dversty iL Adtinal Employee normaton 1 Employer Asian Programs 1 RTAAdvantage Progam © Glsenvuer ede non Sie Depoet ov raine S ‘mploye Slenature owe \Y Box raat pat 753 [mm City of Cleveland Personnel information Document uinsas As of aLEEOE Teagat0 | p28r of um Re Some [wo Pa a Patrol officer T L Cleveland Alt PERSONNEL ACTION JUSTIFICATION Date: _ November 11,2013 Department: —_ Publ Safety Division: —_ Name: __131% Clevelnd Police Academy Classifiation: __Patoloffcer PRe 10588 natin 7 Patna sina re Gay nator ‘tion: statu New ire: eo eget, _< Promation: Temporary Appointee (TA: acssifeation: Unease Union: _O% Loca gawd Cll Service Review: Personnel/HR Reviews ‘Reason/ Justification for this action: —_To full the requirements of Personne! Requisition 10399, Applicant Flow Chart: __Souren of tetera Dispasiton Past Employers Contactod? Ye te Personal References Contacted? Yer YN. duction Godentals Verified? = Yor” No Comments: Background Checks (hires, rehires, recalls only): Felony Conviction(sy: Yes No Comments: ‘ator Vehicle Racord heck Valld_~ “Suspended i teense Personnel Administrator: ao ‘Commissioner: Director: a cate ay, 2013 er ate, Depwenet oat ey, niente Fon ec avon ‘ contre alam Irina Grade street Aasress ly, state and zip xa Repedelephone Nabe (covetang o wv soaze2, piateiet Opecsbiois university ie proterved, thes yours of £011 tine gala continue experi sittin te te four yin tn te ogtvsen ot a helleeontier ip the state ot hia tea st have Ohio Saace Ceticat Training headeny (0.P-0.2-A.1 age 2 of 2 ‘PERSONNEL REQUEST EVALUATION FORM. Ws ts pation apna?) Wien dias eave? Was Was ode postion? Wn, Wat pon ara you Wading a Tar is OnE “Waar pcs SRO paog Mana ONSET HR oan TT, ww he WORT WE res ert cent responsoits? stm, saflng shat and ha sft ofthe liens fhe yo Clesland woul bopopacend ‘ast ara a speci als fis postion? (Passa be spe: Bo ik quote GT Sonic Giles Sater) |-ern ne rogues nfermationto pass OPTA, sie xampation Cerpets me 6 ments pretaton pied. Answer ra [sirens ora mate pace reports iat arate ian ragraians © Gaattcans oT postion? (dude Tans Suc, TOTES] |#8'son some GED. ‘We en sins nan ssignmen preamind baru savant Ha canbe aad? Heo whats The | etesalnant ad why can ur cent st Be wend? i ote Tor ona or ers peoples te wa Taaucad BBO ings WaCaNCT? TT, BAY reduction in tae of onsy sha te 7s aT SRR Sa a GAT ST SIRT CT SAN ST ST TTS aay ae Secon ay cee Taped Sea Tasos renner PES Ths ronosonwi0x2 | ™Baetand Paice Pesenrat unt | _ soptonbers, 2013 Sata gases er Se Bans TT lay pease nay aed Bie “the Proponents opcate SSE FSET] re ont a eons a a aaars Oe |ELrveroved £1 oeited -flromoes Oo Siontres Sorat ns het Eroeymen Aiten ‘ork OW Srice Bam tppeten © City of Cleveland Department of Human Resources and Civil Service Commission Application 602 Lakeside Avenue. Cleveland, Ohio 44i14 http://wocty.cleveland.oh.us 3ob Hotne: (246) 664-2420 [Rise sey othe Gy af Geta oe eal oppor henplrae and SBarczroa sa RIMES HENTES WiO | "eget act color rele, ape, sex, rational gn ance, ny, nee vamato,osexilonentton. Dlctnaton rnd eral see, nd ty Orc "TO BE CONSIDERED FOR EMPLOYMENT: 1 Fl outapoation completly and aver ever question fly 2) Do not ptf to recur 3) Be sure to ln anddate | ne applcton. [PERSONAL INFORMATION - eo im [Efe Leawe, ———Cleveinas lon ! ~ |ggecermeaomeenccannaraang_ aw {gMexcencycoMTacr = oF cxevelens [TYPE OF WORK DESTRED. si ed TRE a |.-Potire Orercar Ofer Ns pte eles can you po Vd Sa Ohara Comal Dre we?) O75 _O te etmetetnsimer von, ac ON Hs oe ie! ‘Pattie! fm) veel uo thera Eros we youve twat: Oe Mo_CYas Co _Dves lo _OYes CMe _O Yer On ‘SERVICE RECORD — — 7 Serine [area re cae Aj ie A vis | ‘recreate Ot? ye, pase oven ert yo a Eang Suter (ES) Yes Oho + You mrt ouch dish papers, D024 anor che po of aren fa site cr ape EMPLOYMENT HISTORY et aston rt cr eng ETS WA Ra pe a a (a wa aT OTN, a | sSuer nr iay Se tion om rcs) WoT Ub aGPn To REN J tac nent ogres at GSE peas pone oe Oo Se [ime of pope ees igre Seat Peso Nicene ‘enastias [Beet etiortee Soneror | ester ripe fares Ear Too "Gveve Savele, Lieveinadyoh MMIINS We AT 4tele Sia ra — GET Sea ans Wee] Ea We | TRSTEN OF Foe cer ee — Teeninia: Sy) Cngioyed 4 | Ramear aap aaa L_Weicone West Ene athe Ea Pie oT HAO-35le~ FBO | Disece Supoe qratestonnl Mites Sug sit Seo ttt [Faeries “med odrinistewion exe ice. Tina Eo sao ae a waite, en Sios> Gros peir AE yan We ats an Sellar Toray [aa ie | Sa hone cace @ssistont| Ta bene case Loo | Lis Hsien o. mab carer Sere 72 ntoal + iL eR eee == eT, a Levelons sesso gaces 20 AM, Be Used eee POBRSS WAL UEC bs ‘Nl saa To Bes Employment Eligibility Verification uscis Deparment of Homeland Secursy ese elas US. Chm nd Knmigrtion Services erbinote ANTIOISCRIMINATION NOTICE! sepals ducal spre! vert-adrsed vale Englyers CANNOT pany ih Sr) ot got erie, cams Re oamertaon sees hae [Section 1. Employee information and Attestation Enloyosmual comple and abn Solan 1 of Fam [Ore er nan ne etsy of ensloymant ba Ble csplng 8a oer) La nana Fay a) ‘Fates hen ore) ‘aie in [ra Und ar atta) ecnaraar [yar [one Yates as Br a) [US Sot ny ae [Ea re am aware at eral ew prvi for inprecnment andar nes for fale tomar or ue of document in ‘comet wh th compton ofthis fom, aos undo panty of par tet am (check oe of allowing Ba Acta atthe Uta Stas [T Anorcitizen ratiral ofthe Ut State (Soe butions D Aant paren rset (Aon Raison NumberlSCIS Number saat wf enin t Het, e) Sones yw Wl (Sentara) For arsed wr ror hin gon an S08 Mba Of Fem kde Mar 1. Aen Raton bet S08 Noor oR Dons wns one you ota your asin ruber en CBP conection wth you arian tb Ug ‘Sota neuca be sown FersgnPaspon Nmbor. County suaree: ‘Some sane may we NIA' on he Foran Papert Numba ar County of evo Re (See nus saamcrernroe QR nS - ips _| [Preparer andlor Wansiator Corificaion Tobe conpbed and sped Secon Wprpared bya pan ata Dano] lesion) ‘atest under pana of parry tat have alte th compton ons Frm nd that oe Baloo Knowedpe the Intrmaton ere or cor [sation ania) Fane no) — Pas a aT praTen Com © Prior compiasnes rare [Seciion & Employer or Authoilaed Representative Review and Verfiction tenets her ere pie nest capi an sp actor? bes oa beng empayon You spent emiw on sss tom L'Air ne cunt a at so aaa Coe pope Lt tae fet None dM el om ection AACN, ADRIAN ea a a Tae a ey ——— sis SEES re ee ee SS TTT. —— lei i AEE ——~ an 0 TE aes a aa TIT Gertfieation ast under nay of pry, ta (1) have wxaind the document) prostntad by te above-named omployes 2) ne ‘Soveinted acura appenrto be genuine ato ats tothe ompaye named, and (90 tha bast! my knowledge tha ‘raj ie sthorzedo workin he Unto Sites ‘The employee ist day of erpoymant yt 2212/2013 __ (Soe iatruton for exemedens) ee [Sisson [omen rc rare cee Row oa [Section 3. Reverlication and Retires [oe conse and abnad by ensie’ o ahoreed moreverane) shila Al ilimnl [= Fanny pata gt wpa toaion aces pean be ems Sem TonUn ALAC Poa eon one coe robe naront Fae aan sco Te sonar Nice [Eran ioe ott na pel of peur tha oe bet ot my knoladg, ia splays ie autoradio workin dha Untea Sae, ond ‘ecmploye prevented socmantah the eacamanda have wxsinedsppetrto bs groune sao ate otha nue. San cleo arAiboteaeremisie [Svein riNeneal ieee htoredRepearte Toon 9 aw N Pues City of Cleveland Employee Consent Form for Internet/Intranet and E-mail Usage 1, Pdtien coduese have read the Cit’ Policy on Employee Use of E-Mail and Intemet/Intranet (“Net”) and agree to comply with all of its terms and conditions. I understand and agree that all computer and electronic activity, including, but not limited to, electronic mall and Net network activity, being conducted with City resources is the property of the Cty. 1 acknowledge and consent to the City's right to monitor, lg, access, and review all such activity, with or without notice. I therefore understand and agree that Ihave no expectation of privacy in the use ofthese resources. understand that such Cty monitoring may Include printing and reading all electronic mail, websites, and data entered, left, backed up, or stored on the City’s computing equipment, whether or not I have Intended its deletion. Finally, T understand that olation ofthis Policy may subject me to disciplinary acon, upto and including, termination of employment. Employee Name Date . Adan Cader VEVSXD Employee Signature Division Que ecived By (Supervisor or Appointing Authority) Date Distribution of Copies; One Copy - Attention: Department of Human Resources One Copy = Employee Department File One Copy - Division of Information Technology and Services One Copy - Employee cet STATE OF OHIO WHISTLEBLOWER PROTECTION POLICY 1 Adela, Cealboun confirm that I have received a copy of the 3 pages of the Ohio Whistleblower Proteetion Policy. OL PAK + 3-S-13, Name Date - __ go Social Security Number Date of Birth Acknowledgement of receipt of Auditor of State Fraud-reporting system f ink Pursuant of Ohio Revised Code 117.103(B)(), a public office shall provide information about the Ohio fraud-roporting system and the means of reporting fraud to each now employoe upon employment with the public office. Each new employee has thirty days after beginning employment to confirm receipt of this information. By signing below you are acknowledging the City of Cleveland provided you ‘information about the fraud-reporting system as described by Section 117.108 (A) of the Revised Code, and that you reed and understand the information provided. You are also acknowledging you have received and read the information regarding Section 124.341 of the Revised Code and the protections you are provided as @ classified of unclassified employee if you use the before-mentioned fraud-reporting, system. [Raster Cavan, have rad information provided by my omployer regarding the Baud reporting oyotom operated bythe Ohio Auditor State's office. I arhor stato hat tho undoroignod signature acknowledges receipt of this information Qsan tmiase Quid caters Print Name, Title, and Department Modan nn Nea Please Sign Name Date CITY OF CLEVELAND Mayr Frank. jackson CITY OF CLEVELAND ETHICS POLICY T_fadclon Centeaun confirm that I have received a copy of the 8 pagos of the City of Cleveland Bthies Policy. AAgeA _cen\no, VAS, Date Name — . . oO Social Security Number Date of Birth, € at pera En CITY OF CLEVELAND Mayor Frank G. Jackson OHIO ETHICS LAW AND RELATED STATUTES 1_Advton Cond confirm that I have received a copy of the 24 pages of the Ohio Ethics Law and Related Statutes as required under the Revised Code 102.09(D). ‘Social Security Number Date of Birth City of Cleveland Statement Concerning Your Employment in a Job Not Covered by Social Security Frank G. Jackson, Mayor Employee Name Ana Cotaciin Social Security? ‘Your eamings from this job are not covered under Social Security, When you rei, oF if you become disabled, you may receive @ pension based on earnings from this job. Ifyou do, and you are also entitled to a benefit fom Social Security based on etter your own work or the work of Yyour husband or wife, or former husband or wife, your pension may affect the amount of the Socal Securty beneft you receive. Your Medicare benefits, however, wil not be affected. Under the Socal Security lav, there are two ways your Sodal Security benefit amount may be affected, Windfall Elimination Provision Under the Windfall Elimination Provision, your Social Secu retirement or csabiity benefits figured using @ modified formula when you are ago entitled to @ pension from a Job where you id not pay Socal Secury tax, Asa result, you will receive a lower Sociel Secuty benefit than it you were not enttied to a pension from tis job. For example, if you are age 62 in 2005, the maximum monthly reduction In your Socal Security benefit as a result ofthis provision is $313.50, ‘This amount is updated annually, This provision reduces, but doesnt totally eliminate, your Social Security benef. For addtional information, please refer to Socil Security Pubication, "Windfall Elimination Provision.” Government Pension Ortset Provision Under the Government Pension Offset Provision, any Socal Security spouse or widow (er) benefit to which you become entitled wil be offset if you aso receive a Federal, State or local ‘government pension based on wrk where you did not pay Social Secuty tax. The ofset reduces {he amount of your Sodal Securty spouse or widow(er) beneft by two-thirds of the amount of your pension. For example, ifyou get a monthly pension of $600 based on earnings that are not covered under Social Security, two-thirds of that amount, $400, is used to offset your Socal Securty spouse or widow) benefit. IF you are eligible fora $500 widow(er) benefit, you wil receive $200 per ‘month from Sodal Securty ($500 - $400=$100). Even If your pension is high enough to totally Offset your spouse oF widow(er) Socal Securty benef, you are sil eigible for Medicare at age 655, For addtional Information, please refer to Socal Securty Publeaton, "Government Pension offset.” For More Information ‘Socal Security publications and addtional information, Including information about exceptions to ‘each provision, are avaliable at wwn.sacalsecurty.gov. You may aso cal tol free 1-800-772- 1213, of for the deaf or hard of hearing call the TTY number 1-800-325-0778, or contact your local Social Securty offic. {eertiy that I have received Form SSA-1945 that contains Information about the possible effects of the Windfall Elimination Provision and the Government Pension Offset Provision on ‘my potential future Social Security benefits. Signature of employee 4 Xp A pate W2xS A Fam SSA-1985 (15-2004) (Ceres nur, 2009) CITY OF CLEVELAND DEPARTMENT OF HUMAN RESOURCES EQUAL EMPLOYMENT OPPORTUNITY [AS an equal employment opporturity employer, the Cly of Cleveland adheres to all federal, state and local laws, rules and reguations as they pertain to equal employment opportunity and affirmative action. The Information requested below wil assist us in analyzing our affirmative action efforis, We ask that you complete the information below on a VOLUNTARY basis. Any inclusions or exclusions will NOT affect any application or ‘employment decision, The data secured willbe used for statistical purposes only and wil be maintained In 2 separate confident il (PLEASE PRINT) DATE _1\ 5 wis NAME ADDRESS C\evelond, Ola POSITION APPLYING FOR _Qo\ice OS8icec HOW DID YOU LEARN OF THIS OPENING? _A\evecsice CHECK ONE: Female CHECK THE BOX OF THE RACIALIETHNIC CATEGORY TO WHICH YOU IDENTIFY: caWnite American Indian/Alaskan Native ([oAfriean American CiAsianPacific islander Hispanic Other CHECK IF ANY OF THE FOLLOWING ARE APPLICABLE: (Vietnam Era Veteran CaDisabled Veteran [DDisabled individual BIRTH DATE __ — BA CIVIL SERVICE TESTING This notice is to inform all prospective City of Cleveland employees of the Civil Service testing requirement CIVIL SERVICE TESTING Ifyou have been hired by the City of Cleveland from a Civil Service list, your position status is "regular." If not, your status is “temporary” and you are subject to testing through the Civil Service Commission. The Commission conducts examinations to determine your qualifications for the position for which you have been hired. If you do not pass the test or score sufficiently high enough to be appointed “regular,” your ‘employment with the City of Cleveland may be terminated. By signing below, | acknowledge the implications Civil Service testing may have on my future employment with the City of Cleveland. Dire Is R Applicant's Signature Date AuTHON IN ‘AND WAIVER OF PRIVACY RIGHTS Pease read the flowing before soir: 1 < hereby authorize the iy of Cleveland and its agents or employees to ‘hae rerpojer meses ens) cond» background deck on me and author the release of pertinent information angering me ram any source, Including, Duk no ted 8, past erpayers. “The undersigned appar, in granting this appeation, hereby specifically WAIVES ay right to PERSONAL PRIVACY he or she might have inthe above lfermation and RELEASES the Cty of Cleveland and any person er agency fort ANY LABILITY WHATSOEVER rsuting fom the rlese of uch Ifermaton NOTE: Pubic Law 91-508 requires that we advise you that 3 routine nquy may be made which vat provide appicabe formation concering characte, general reputation, and personal charactrstcs ROUTINE INQUIRIES MAY INCLUDE PERSONAL INTERVIEWS WITH FRIENDS, NEIGHBORS, REFERENCES AND PAST EMPLOYERS. Upon wen request, adonal information ast te nature and Scope of 3 resulag report fone s made, wl be provides, My signature below cris that my responses o the Application for Employment Sere Test Arpcaion are true and complete to thebestof my knowledge. T understand that employment is based on competion ofl pre-engloyment requirements and procedures which ay Weld! Interviews Urine drug screen and pre-employment physical Dron of eenty ant empnymen sie Far work nthe LS Edyeation and reference checking “esting (i applable to the postion for whlch you are applying) Cina and motor veil recor check ‘Consumer report check {In addition, f understand that any offer of employment will be contingent upon the results of @ physical ‘examination by authorized medical personnel of or forthe Cly of Cleveland, Compliance withthe Gity of Cleveland's Drug Testing Policy Isa condition of employment: Therefore, a Job offers are made withthe understanding that prospective employees pass adr screening tet prict to being hired. {understand and agree that any falsification or omission, either on this form or in response to questions ‘asked during my interview or examination processor on employment forms 1 subsequently complete, Including 1-8 forms, shall be grounds for immediate termination, no matter when the falsification or comission is discovered. —AN-\SAS A Date ‘Signature of Employee or Prospective Employee 2 BA — Bate of birth ‘Social Security Number ‘current Brivo" Lidénse Number ‘Commercial Driver's License Type & Number ( REFERENCES REFERENCES oof ens mec seins commntson (Do tt lav) Tae es eeporeWonber Kae buenas De H10- eH NYRG 535-8750 [iene — a ie ____ Toy 901-3885, - = + Aa Aa x _ Wee AaB Wis WR crits} | oer oT . ‘Sena godine you nc nono eS CPR = ae a + atin ba te arenes Love ade to ea and of he cutis spon ae cele rd 9 9 HE SOY {ain a ne arn ert! den nel ry be conser safer cus fer Sc enon OT toons a bl 8 eof in fr my ys eon ws EN ES erly hers Le leer artes cht ter, or at enove, tom GAGS oy SS soy ete ato ed tdean toy event a ery coed thik ey SSE Sc) ONES ifomazon wich ty Ete Pe Fey oan coset Yo te eas of my pl Es NCE Stamuetco f ome. een cy of Sevan, ana wate aye > personal pricy Tight Rave “a apping tr ele whey of Cevean, tundra tf evade to oft erase of yf ear ee eT habe scooter conan wich he Cy of Ceeand may aR vt wander x, te stakeents mae by ns pplcaton ee ne, aoe an coe 10S as ee sma on te sap nab stn case termination rom employment wth he Ch, exe emany sonata remo oy ame fon SOs tae by fe evans i Serve Comms sonanure otapoicant: \A3.. pate LS-Vy Adrian Calhoun Personnel File — Div. of Police Dept. of Public Safety i CLEVELAND DIVISION OF POLICE DIVISIONAL INFORMATION eel coat sexvice raw: _{p 4 “Teflon lefocmton abe forthe Pttanael Uns reed y vasrmuns CON I —— merinne AR — oats py mance RIT oe WY et Den oir OE pale ApDnESS: cmy:_cleveland zircove: : PHONE: neawisrosruce Af samannane:_/V (A EMERGENCY CONTACT: ___ RELATIONSIUP,_sraynee PHONE: / MansratsraTus: (v1 YEARSOFCOLLEGE:_Q) HIGHEST DEGREE OBTAINED:_A/ID\ NaMEOF DEGREE: fy 2 ae SERVEDINMILITARY? _fyq___-WARTINE VET?_p wien wane {8 ARE YOUFLUENTINA POREIGN LANGUAGE? _ AC) wauea ancuacer YQ) sce jo wast C1087) ae HAVE YOUEVERBEEN: — LAOFF: DISMISSED-TERMINATED:, EstGNED: eIviLIANs ONLY PERSONNEL INIT USEONTY access om O m O woes City of Cleveland Fran son pe Depserereo pbc Stay eter Seeing oupanteirs ieepesise tac Ne o64754 Sows ‘November 11, 2013 Adsian Calhown Cleveland, Obio Deer Adrian Calhoun, Ik is my pleasure to inform you of your appointment to the position of Patrol Officer in the Cleveland Division of Police, Depariment of Public Safety, effective, Monday, November 25, 2013. You are to report to the Cleveland Police Academy, 1300 Ontario Street, Room 731 at 0800 hours ou Moadsy, November 25, 2013. Enclosed are insieutions regarding dreas cede and other information you will need when you report. ‘You are advised that you ae subject to a final revord check reganding traffic violations, criminal convietions, and traffic accidents prier 1o your appointment date. Signifiant changes in your background or medieal situs may be grounds for reseission ofthis appointment. ‘You are required to contact the Division of Police Personne! Unit at 216-623-5136 to report any changes in your status, Sinestely, Sincerely, Marin L. Flask, Difector Department of Public Safery 4 Ey Opry Empoe Eligibility List \_-nber - 69 Personal History Statement TG & DEPARTMENT OF PUBLIC SAFETY DIVISION OF POLICE Eligit'“y List Number_ YP CLEVELAND DIVISION OF POLICE PERSONAL HISTORY STATEMENT ‘This Personal History Statement is intended forthe ust of the Clevelend Police Department. Failure to provide complete and truth informaion will result in rejection for eppointment parsuant to City of Cleveland Civil Service Commission rules, andlor discharge after appointment. All information is subject to independent verification. All documents filed withthe City of Cleveland ae public records, ‘The answers to questions contained in this Personal History Statement must be legibly printed in your own hand. Each individual question must be answered; there can be no blanks. Ifa question does not apply to your particular circumstance, inser “DNA” (does not apply) in that blank/section. . Whe answering questions that require dates, insert the full date; partial month/year responses are uunacoeptable. You must provide complete address information, including 2ip code, when requested. Partial address information is not acceptable, Additional space for explanation or clarifiction regarding your responses can be found in Section 11, page 14. ‘Applicants are cautioned to answer every question trthfully and without evasion. The Ohio Revised (Code provides penalties for msking false statement of a material fact, or for perpetmting any fraud or deception in obtzining, or attempting to obtain municipal employment. Penalties include rejection for ‘appointment, discharge after appointment, andlor prosecution under Ohio Revised Code Section 2921.13. Applicants are required to provide originals of the following documents atthe time of the Personal History Statement Review: (1) Birth Certgcate (2) ligh School Diploma or GED Certifieate (3) ‘Valid Drivers License (4) Secial Security Card (5) DD214 ~ Long form (for Miltary service) (6) ‘Marriage Cerificate (7) Divorce Decree (8) Naturalization Papers. These documents will be copied by investigators of the Cleveland Division of Police Personnel Unit st the time of the interview. Any ‘additional degrees/cenificates that you have acquired may be included with your Personal History Statement If you are presently self-employed, or have been selfemployed, you must submit copies of the prior three (3) years Federal, State, and Local Income Tax returns (both personal and business tax returns) In addition, you must submit the names, addresses, and telephone numbers of five (S) business clients. Failure to fully complete the Personal History Statement or to submit the required documents will Gelay investigation of your suitability for employment and may jeopardize your appointment to the (Cleveland Police Department. ‘You must notify the Division of Police Personnel Unit, (216) 623-5135, in writing of any changes relating to your residential eddress, criminal or arest history, traffic offense history, driver's license ‘status, marital stars, and any changes in employment stats or employers, This information may be faxed to the Cleveland Division of Police Personne] Unit at (216) 623-5820. Failure to do s0 will be rounds for further review of your qualifications for the position of Patrol Officer with the City of Cleveland. PLEASE NOTE: This document MUST be notetized before your Personal History Statement review appointment; please see page 15 for Notary statement, 1 Eligit"“ty List Number @O4 eee Saar ame: _CO\WOIA FirstName: Ahoy ML Maiden Name/Nick Names/aliss: [nt Pk Social Seourty Number: DeteofBink: —_/__—/ 989 Place of Bit: _Clave\oun Oh Gy —Canclagae. — Sa Age 32 Height_(p'Y Weight 334 __ Hair Color: Ble Bye Color: HOt List any tatios, scars, or unusual birthmarks youhave: (no babioo Qiasea on tht ces Srosins persue 2 tg Obie Drivers License Number: __ Typ: Expiration: aaa Outer Sute Operators License Nunber Tove Sue: DA Expiration: OMA ‘Are you an American Citizen? (__) Yes (DAA) No ‘Are you a permanent residentalien? (V0) Yes (DN Be) No [Ifyou are a naturalized citizen ofthe United States, ls the information below: Dyk _Dva__ Dvr Caries Naber oes a sean ars ete An ea tae Name of Curent Spouse: __ (Yn Dateof Mariage: _ NN Spouse's SSN: Qn - Dhak - Typ Spouse's Date of Binh: DA 7 Daya / DAP 4G) Areyou supporting all dependents you ae required suppor? (Dus) Yes (ast ) No + @) Areyoupaying cit suppor orstmony? (Que) Yes (_W~_) No feo, amount peid pet month: $ CAUB —_Collesing Agency: ONL ¢ @)__Have you ever been sued for als. y payments child support, nonpayment of deb, or fraud as it pertains to State of Ohio Child Support Laws? (oma) Ys (oY _) No 2 iigibiy List Number_WM tion: lence Information Stating with your present address and working back, list each address at which you have resi since age 18, Include addresses while at school and in the military as well as family owmed fevilities. For college on-campus residences, give the dorm name, address, city, and state. If residence in the military cannot be shown a @ steet addzess, indicste the complete military unit designation and location by city, state, and country. If renting or leasing, include the landlord, agent or management ‘company to whom you paid ent. Lease —DateFrom / To Street Address/ Ant. if SitwSsiate Zip ‘Own “beese Deka. to Present _ = Saar, EER Soca eta — Litdinadicha ase Mosk to Spay, etna bo ' ins NOVAdG to egy ee -Llavielncdth esc Clem t Ahaha, —— Hievdand On _ fatets Suyamio to Sot ior - Geveleadon 44 Qe Qe © Dea rp tt Swnwk_ » Due tan A Mua Qua © yup ——huh —__Qub__ SNe Due w Dyg > Oye pe awh Sua © De —_Dwa ___ __Ov A _ Sos Duk © Data Dope __s_pwa _ REREPES Curent Residence Telephone Number: ( wo Sahin Sone oF st (Current Employment Telephone Number: (2 ), __ a sanye Cintsite/ Hatse shoe Phone Number for Messages: (Dok De Poger Number: (Dah DQ 4 Have you ever been evicted or takeu t0 court for non-payment of rent or for damage done to any leased dwelling? (SYQ\K) Yes (_¥__) No 3 Blighty List Namber_W™ High School: Name of High Shoot: Yymes & QModes Fall Address of High School: Sion iasiois aut, Cltueiand De utis Graduated: (__y~_) Yes ( OMVAL) No Yearand Month of Graduation: \ya-o8 you di not graduate from High School, what was the highest grade completed? _ CVV General Educational Development Test (GED): Do youhavea high school euivalencydiplome? (Due ) Ye ( Owa ) No Issuing Site: _Q)0V Cerin amber. _ DN Date: QE ‘Test Date: ok ‘Testing Agency: DAA Coneges 5 Name of College: snihueten FAM OO NOt ChE jsf ei omy 4ans Years Attended: From (QQ to OB _DegreeReecived: _picn Wisi REgleRe ake Minor: _ (NA GPA. Ou Ifyou did not greduste, approximate number ofcredithours takes: SS ANA ‘Technical and Trade Schools: Name ofSchool: American Cedcsass Full Address of School: ow x ‘Years Attended: From poy 3anth Signe Norm AreaofSmudy: _qyts ‘Year of Graduation: ovo, Degree Reveived: STINE Cec light" List Number_ (ef ‘Section 4 — Military History ‘Have you ever served on active duty in the Armed Forces of the United States? (Dale ) Yes (_ VW) No Brenchof Service: _ DNS vnc _ aia ‘Military Active Duty Dates (do not include short reserve tours of 90 days or less): ‘From: Dora To: vf ‘Highest Military Rank or Rate Held: _|YNY Py TypeotDiscimee: _ 1) NB Military Reserve Sus: ( (\MR _) Active © QA) Inactive {you sil stend drills the name and location ofthe attending military bate: BERET ford se Ue e000 00ue0000 0000000000 50eesee8n00008 ‘¢ (1) Have you ever requested or received deferment from military service? (Qa) Yes (_V_) No + @) Were you ever cour mantisled, ied on charges, or the subject of a summary court manial captain's mas, or Article 15, while inthe Armed Services? Ca) Yes (_Y_) No © G) Have you ever requested or received an upgrade of the 1ype of separation you curently hold fom any branch of the Armed Forces of the United States? CR) ves (VY ve ‘+ ifyouranswer to #3 is yes, indicate the date and original type of discharge _ {VI Qs Eligh"y List Number_@ML Scetion §~Emplovment History Begin with your current job and list your complete work history in revere chronological order, ic most recent o least recent. include inthis sequence all parttime jobs, periods of unemployment, and ‘military service. All address information must be complete: number, street, apartment or suite, city, ‘Rate, and zip code. For military service, subttte for the name of your immediste supervisor, the ‘name and rani of th last conumissioned officer who was your immediate commissioned superios. For peviods of unemployment, indicate the dates in the spaces provided. In the space designated “Employer” write in "unemployed In the space designated “Reason for Leaving” indicate from what source you received income diring that peiod of unemployment. Your entire work history must be ‘sccounted for, Do not slp any te periods. From: precy \aryoxe To: Present Job Tite: BERS colomto ‘Ave, Employer: Qc laa of Address: “ays, Onin wuoil” __ 0 Immediate Supervisor: Goctasta Soa Business Phone: ve, GL 0S) Description of Your ues: peot/idtan neile cate SecVLeG athe goa oF Hatt bones ‘Reason for Leaving: _ OYA Disciplinary Actions: _ AEE Work HoursShift ope 383 anor Ta From pySceb— Te: gonens JobTie: Coane comma C68 Employer: Sar /orsesine Crimes AMES oo Pinte square Cel Oe MANS Immediate Supervisor: Jaaye Ctantiee! Kat Business Phone: Qu p88 Nar wa Description of YourDutes: Colicc+ ad pincass tustnt Reason for Leaving: {Yai Disciplinary Actions: TD) Ni fy ‘Work Hours/Shift yop? 8°" yea Blgit “ty List Namber_WM_ ‘Section § = Emplovment History (cont) From [pig-t) — To: Zycra eb Title: _Seeyersy OFeicec Employer: Ceosas anti Hatseciee Che. AMES ion puniic Squnte 61K nyt Immediate Supervisor ov Seawes Benstan — Business Phone: Quay yett-S\ Deseition of Your Duies: Gra) Bing, S2Ciutny tol Sossiy ts tae Pusaic Reason for Leaving: f. Wuacesnea® Disciplinary Actions: ) 0) fA Work Hous/Shift 49 / yer Immediate Supervisor _T)N\ 0 Business Phone: _() tN Deseription of Your Duties: _ YA} 0 Reason for Leaving: _\nomngio4 ment Compensation Dnt hs woikHouwsnit Day Disciplinary Actions: J poe: spite. Tahaan. WE Sites , TR Arid eater os raisin meer _ yal is Se Wich Description of Your Duties: _ trai Au see Reason for Leaving: Jobeoah " Disciplinary Actions: tention det bo sugiteh ch cetticats Wark Hours/Shift Yo/ wae. eS light ty List Number U4 Section § Employment History (cont) From poo hont Te Secknona OTHE Disc supgase gees Eaplye: swag soosdasion scat. MARS {1 emosgent tanaeh Inmet Superior: _ DAN ind Pane iS Wet Desipionof YourDutes:_gaselion snag eeeatel ‘Reason for Leaving: yy guy ke Sibi ‘ i Disipinny Ati _ DAG WorkHousttin 28 ee From: S.x4 nee Te: Sola gang JobTite: foie Employer: _ynger passe Adéress: ache Immediate Supervisor: _g\vi 0 Business Phone: [Yap Description of Your Duties: QS by Reason for Leaving: AL) ore \asusi@ Can Saree Diseiplinary Actions: Ty ii ‘Work HouShift at pa erences sea From: Smeaone Te! sascreng bTille: Tyas A Employer: zoeveiank netin ques eon AMMeSS! Beh 24 WAALS enh Siniagh MA, Inmediate Superior: _ Oats ‘Business Phone: gai Description of Your Duties a ; Retson for Leaving: od rei ee Qoeaesctve tor faGatst amis Duh ‘Work Hours/Shift sheng od —_—_—————— Disciplinary Actio additional room is needed, attach a separate sheet of paper. Blight “ty List Number_(@M4 ‘Section 5 Employment History (cont) + (1) Have youtaken a polygraph exam forany reason? (Tye) Yes (_W7_) No Dawe: Diy __Loeation: _ ve. Reason: Sv ¢ (2) Have youever been rejected for bonding? (Oi ) Yes (Ly) No 4 () Within the pat seven (7) years, have you taken a Civil Service Entrance Examination for the ‘position of Patrol Officer with any lw enforcement or other governmental agency (including the Cleveland Police Department)? (Dw) ve (_v_) Ne Date of Test a Ni ‘Section 6~Traic ond Driving Resord “List all moving citations served upon you by & aw enforcement officer, coun, or other authority in any slate ot country for violation(s) of traffic laws or regulations. Parking tickets do not apply. Date Offense Tgeaey Disposition e 5 te cu = x ai Lis all traffic avidents you have been involved in ss the driver of ax automobile, Date [. Location geney Was you ced? | Injury Involved Eligh “Uty List Number TOY + 0). Doymemeatytuve miomebioiosmme? — (_y-“_) Yer (fiir) No foitearno, Jnsrance Company: Sage Ayyha Agent Phone eop- Baa + @)_ Has yourDiivers License ever been evoked/suspended? (Paid _) Yes (_V_) No ‘Year of Suspension Tae of Suspension ‘Reason for Suspension fy A Pe NR NE Dye NR Si © (1) List ALL arrests, incloding any resulting in youthful offender treatment, arrests which were

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