Special Officer Background Form

Your name appears on a NYC Health + Hospitals Civil Service list for Special Officer.

Since the position of Special Officer is a law enforcement position, you are required to complete a background investigation before you proceed to the selection process. In order to be eligible to participate in the Background Investigation process for a Special Officer position you MUST meet the following criteria:

20 years of age
United States Citizen
Resident of New York City

Have a High School Diploma or GED
Valid Unexpired NYS Driver’s License

The background investigation process is initiated when you complete the Comprehensive Personnel Document (CPD) that was emailed to you and provide the supporting documentation listed below. The CPD must be completed in full. DO NOT leave any fields or questions blank! Carefully review your CPD and all supporting documents prior to submission.

Once all documents are submitted, a representative from the Office of Civil Service and Background Administration (OCSBA) will schedule a WebEx appointment with you to review your documents.

Thank you for your interest in working at NYC Health + Hospitals.

Are all documents available for upload? Refer to initial email for a detailed list of required documents. *

Yes No

You have indicated that all documents required for upload are not available at this time. Please contact OCSBA at specialofficerhhc@nychhc.org for next step instructions. The subject line of your email should state "Special Officer Background" and your name and contact information must be included within the body of the email.

Please enter the following details. * denotes required fields

NOTE – If any information entered below changes during the background process, please contact OCSBA at specialofficerhhc@nychhc.org to update.

LEGAL NAME

First Name *

Middle Name

Last Name *

Suffix

RESIDENCE INFORMATION

Street *

Apt

City *

State *

ZIP Code *

CONTACT INFORMATION

Home Phone Number

Cellular Number *

Personal E-mail Address *

DEMOGRAPHIC INFORMATION

Date of Birth: *

Social Security Number: *

I acknowledge receipt of a copy of Article 23A *

Supporting Documents to Upload

Please upload only ONE document from each of the categories below :

BACKGROUND INVESTIGATION QUESTIONNAIRE *

Comprehensive Personnel Document (CPD)

CONFIRMATION OF NAME AND ELIGIBILITY TO WORK IN US *

US Birth Certificate, US Passport OR Naturalization Certificate

NYS DRIVER’S LICENSE *
SOCIAL SECURITY CARD *
EDUCATION *

Associates OR Bachelor’s Degree

High School Diploma OR GED

Copy of Degree/Diploma not available – Official Transcript, Graduation Letter OR Foreign Education evaluation will be presented in a SEALED ENVELOPE during my in-person interview

PROOF OF RESIDENCY *

Utility Bill, Bank Statement, Credit Card Statement, Rent Receipt OR Lease dated within last 30 days

MILITARY

Certificate of Discharge and DD214 Form

PROOF OF NAME CHANGE

Marriage Certificate, Divorce Decree OR Court Document

ARREST RECORD

Arrest Dispositions

Choose one or more files

Pdf, Jpeg, Jpg, Png, Gif only

Uploaded Files:

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No file uploaded.

For EDUCATION document (Please select one) *

Graduation letter or official transcript will be provided in sealed envelope

Foreign education evaluation will be provided in sealed envelope

I attest that *

The information submitted is true and correct to the best of my knowledge.

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