Form 70-009 ICE 70-009 / 286(g) Partnership Questionnaire

DEPARTMENT OF HOMELAND SECURITY

OMB No. 1653-0047
Expires 08-31-2016

U.S. Immigration and Customs Enforcement
287(g) PARTNERSHIP QUESTIONNAIRE
TO:
Agency:
Address:

ATTN:

Candidate’s Name:

Date:

As part of your request to enter into a 287(g) partnership with ICE pursuant to a Memorandum of Agreement (MOA), please
provide, to the best of your knowledge, full and complete responses to the following questions concerning the law
enforcement officer (LEO) candidate. This preliminary partnership questionnaire does not constitute the full scope of ICE
inquiry into any particular 287(g) candidate's background. The LEO candidate's supervisor must complete this questionnaire.
1. Is the LEO candidate a sworn or certified law enforcement officer employed by your agency?
Yes

No

2. Is the LEO candidate a United States citizen?
Yes

No, A#

3. Will the LEO candidate be able to perform immigration officer functions for a period of two years?
Yes

No

If "no", explain:
4. Does the LEO candidate have knowledge of and experience enforcing the laws and regulations pertinent to
their law enforcement activities and jurisdictions?
Yes

No

5. Is the LEO candidate part of any bargaining unit?
Yes

No

If "yes", identify:
6. Does the LEO candidate's position require the LEO candidate to carry a firearm?
Yes

No

7. Does the LEO candidate possess arrest authority?
Yes

No

ICE Form 70-009 (12/13)

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8. Has the LEO candidate ever been suspected, accused, or proven to have engaged in any of the following types of
conduct or misconduct (provide details and additional documentation for affirmative answers):
a. Employee misconduct in any context?
Yes

No

If "yes", explain:
b. Criminal or dishonest conduct including, but not limited to, false statements, testimony, or reports related to any
matter within the scope of his or her law enforcement duties?
Yes

No

If "yes", explain:
c. Any conduct related to spousal, partner, domestic, family abuse or battery?
Yes

No

(If no, is the candidate 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))?)
If "yes", explain:
d. Any action resulting in any internal agency investigation, formal or informal, regardless of whether any type of
disciplinary action was taken against the LEO candidate?
Yes

No

If "yes", explain:
e. Refusal to cooperate with any inquiry, official or unofficial, or investigation or to furnish any type of requested
testimony?
Yes

No

If "yes", explain:
f. Abuse of alcohol or any drug to the degree that is has affected, or could affect the LEO candidate's performance
of law enforcement duties?
Yes

No

If "yes", explain:
g. Use of illegal drugs?
Yes

No

If "yes", explain:
h. Knowing and willful engagement in acts or activities designed to overthrow the United States government?
Yes

No

If "yes", explain:
9. Do you know of any statutory or regulatory infraction which would prevent the LEO candidate from performing his or
her duties under the MOA?
Yes

No

If "yes", explain:

ICE Form 70-009 (12/13)

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10. Do you know of any reason that this LEO 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

If "yes", explain:
11. Do you know of any reason this LEO candidate would be unsuitable to perform his/her 287(g)-related duties or
exercise his or her authority as delegated by the MOA?
Yes

No

If "yes", explain:

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.
Signature
Printed Name
Title

Date

Mail this form to:
U.S. Immigration and Customs Enforcement
ATTN: Designated 287(g) Program Point of Contact
Potomac Center North
500 12th St, SW, 5th Floor
Washington, DC 20536

ICE Form 70-009 (12/13)

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PRIVACY ACT STATEMENT
AUTHORITY: Information about the law enforcement officer (LEO) candidate is collected and maintained pursuant to the
authority of section 287(g) of the Immigration and Nationality Act (INA), which authorizes ICE to delegate Federal
immigration enforcement authorities to state and local law enforcement agencies. Under the 287g Program, ICE enters
into agreements with state and local law enforcement agencies to delegate to the agencies' LEOs the authority to enforce
certain federal immigration laws.
PRINCIPAL PURPOSE(S): LEO candidate information is being collected on this form to make a preliminary determination
about the suitability, authority and eligibility of the candidate to participate in the 287g program. Further background
inquiries may occur as part of the eligibility process. If determined to be eligible, the LEO candidate will be certified to
enforce certain federal immigration laws, and will have the authority to question and detain individuals for potential
removal from the United States based upon their immigration status.
ROUTINE USE(S): The information you provide may be shared internally within the U.S. Department of Homeland
Security (DHS) for appropriate action. Pursuant to the routine uses published in DHS/ALL-023 Department of Homeland
Security Personnel Security Management System of Records (February 23, 2010 75 F.R. 8088), ICE may share this
information with federal, state, local, tribal, foreign, or international agencies if the information is relevant and necessary to
ICE's decision to delegate authority or issue a security clearance to the LEO candidate; or as otherwise authorized under
the Privacy Act of 1974, 5 U.S.C. § 552a(b), and pursuant to the routine uses published in the cited DHS system of
records notice.
DISCLOSURE: The disclosure of information on this form is voluntary; however, failure to provide the information
requested will disqualify the LEO candidate from further participation in the 287g Program.

ICE Form 70-009 (12/13)

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