Form 70-009 287(g) Partnership Questionnaire

Office of State, Local and Tribal Coordination

OMB No. 1653-0047
Expires 05-31-2013

U.S. Department of Homeland Security
500 12th St, SW
Washington, DC 20536

DEPARTMENT OF HOMELAND SECURITY
U.S. Immigration and Customs Enforcement

287(g) PARTNERSHIP QUESTIONNAIRE

To:

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

From:

ICE OSLTC 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
yes
no
enforcement activities and jurisdictions?
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)

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yes

no

ICE Form 70-009 (04/10)

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):
a. Employee misconduct in any context

yes

no

b. 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
c. Any conduct related to spousal/partner/domestic/family abuse or battering

yes

no

d. Any conduct resulting in any internal agency investigation, whether formal or informal, regardless of whether
yes
no
any type of disciplinary action was taken against the LEO
e. Refusal to cooperate with any inquiry, official or unofficial, or investigation or to furnish any type of requested
yes
no
testimony
f. Abuse of alcohol or any drug to the degree that is has affected, or could affect the candidate's performance of
yes
no
law enforcement duties;
g. Knowing and willful engagement in acts or activities designed to overthrow the United States
yes
no
government by force
9. Do you know of any statutory or regulatory bar which would prevent candidate from performing his/her duties under
yes
no
the Memorandum of Agreement?
10. Do you know of any reason that this candidate's credibility could be called into question when testifying in any
yes
no
criminal proceeding as related to Giglio v. United States, 405 U.S. 150 (1972), or its progeny?
11. Do you know of any reason this candidate would be unsuitable to perform his/her 287(g)-related duties or exercise
yes
no
his/her authority as delegated by the Memorandum of Agreement?
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, Local and Tribal Coordination
500 12th St, SW, STOP 5014
Suite 5023
Washington, DC 20536-5014
to the attention of your designated OSLC Point of Contact.

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ICE Form 70-009 (04/10)

Public Reporting Burden. U.S. Immigration and Customs Enforcement is collecting this information as a part of its agency
mission under the Department of Homeland Security. The estimated average time to review the instructions, search existing
data sources, gather and maintain the data needed and completing and reviewing this collection of information is 25 minutes
(.416 hours) per response. An agency may not conduct or sponsor, and a person is not required to respond to, an
information collection unless it displays a currently valid OMB Control Number. Send comments regarding this burden
estimate or any other aspect of this collection of information, including suggestions for reducing this burden to:

Department of Homeland Security
Office of the Chief Financial Officer/OAM/Records Branch
U.S. Immigration and Customs Enforcement
500 12th Street, S.W., STOP 5705, Washington, DC 20536-5705
(Do not mail your completed application to this address.)

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ICE Form 70-009 (04/10)