Form 70-009 287(g) Partnership Questionnaire

DEPARTMENT OF HOMELAND SECURITY

U.S. Immigration and Customs Enforcement

287(g) PARTNERSHIP QUESTIONNAIIRE

To:

(Local law enforcement agency leader requesting 287(g) Partnership)

From: ICE OSLC Assessment Group

As part of your request to enter into a 287(g) partnership with ICE pursuant to a written agreement in the form of a Memorandum of Agreement (MOA), please provide, to the best of your knowledge, full and complete responses to the following questions for each proposed law enforcement officer (LEO) candidate that is employed by your agency.

This is a preliminary questionnaire and does not constitute the full scope of ICE inquiry into the background of any particular 287(g) candidate.

LEO Candidate’s Name

Date of Completion

1. Is the candidate a United States citizen? yes no

2. Is there any reason why this candidate will not be able to perform immigration officer functions for a period of (2) (two) years? yes no

3. Is the candidate part of any bargaining unit? yes no

4. Does the candidate have knowledge of, and have enforced, laws and regulations pertinent to their law enforcement activities and jurisdictions? yes no

5. Is the candidate a sworn/certified, full-time law enforcement officer employed by your agency?

(TF only) yes no

6. Is the candidate authorized to carry a firearm? (A “yes” answer affirms that the candidate is not prohibited from carrying a firearm pursuant to any State or Federal law, including, but not limited to, the Lautenberg Amendment (18 U.S.C.§ 922(g)(8) or (9)). (TF only) yes no

7. Does the candidate possess arrest authority? (TF only) yes no

8. Has the candidate, at any time, been suspected, accused, or proven to have engaged in any of the following types of conduct or misconduct (provide details for affirmative answers):

1. Employee misconduct in any context yes no;

2. Criminal or dishonest conduct to include, but not be limited to, false statements, testimony, or reports related to any matter within the scope of the employee’s law enforcement duties yes no;

3. Any conduct related to spousal/partner/domestic/family abuse or battering yes no;

4. Any conduct resulting in any internal agency investigation, whether formal or informal, regardless of whether any type of disciplinary action was taken against the LEO yes no;

5. Refusal to cooperate with any inquiry, official or unofficial, or investigation or to furnish any type of requested testimony yes no;

6. Abuse of alcohol or any drug to the degree that is has affected, or could affect the candidate’s performance of law enforcement duties; yes no ; and,

7. Knowing and willful engagement in acts or activities designed to overthrow the United States government by force yes no

9. Do you know of any statutory or regulatory bar which would prevent candidate from performing his/her duties under the Memorandum of Agreement? yes no.

10. Do you know of any reason that this candidate’s credibility could be called into question when testifying in any criminal proceeding as related to Giglio v. United States, 405 U.S. 150 (1972), or its progeny?

yes no

11. Do you know of any reason this candidate would be unsuitable to perform his/her 287(g)-related duties or exercise his/her authority as delegated by the Memorandum of Agreement? yes no

My statements on this form, and any attachments to it, are true, complete, and correct to the best of my knowledge and belief and are made in good faith.

Printed Name and Signature (sign in ink)

Title Date

The form should be mailed to:

U.S. Immigration and Customs Enforcement

Office of State and Local Coordination

Potomac Center North

500 12th St, SW, 5th Floor

Washington, DC 20536

to the attention of your designated OSLC Point of Contact.

Page 2 of 2 www.ice.gov ICE Form 70-009 (04/10)