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HomeMy WebLinkAboutRocco, James OATH OF OFFICE FOR FIRE POLICE- RECEIVED STATE OF NEW YORK OCT 2 3 2019 Southold Town Clerk COUNTY OF SUFFOLK I, JA,-'r-( 2� o c Go DO SOLEMNLY SWEAR THAT I WILL SUPPORT THE CONSTITUTION OF THE UNITED STATES, AND THE CONSTITUTION OF THE STATE OF NEW YORK,AND THAT I WILL FAITHFULLY DISCHARGE THE DUTIES OF FIRE POLICEMAN OF THE 6v~re�050 FIRE DEPARTMENT/COMPANY, ACCORDING TO THE BEST OF MY ABILITY. SIGNATURE ADDRESS OA-MITO cry , tJ °J 119 52 CITY/STATE/ZIP SUBSCRIBED AND SWORN BEFORE ME THIS ��- DAY OF ®cIto ALe- 20 /q MICHAEL R.BARRY La (30TAFi`. PUBLIC,State of Newyork No.01 BA6207859 Qualified in Suffolk Coun te �f NOTARY PUBLIC New York State Division of Criminal Justice Services RECEIVED PEACE OFFICER REGISTRY ENTRY FORM -CERTIFICATION OF INITIAL EMPLOYMENT (Executive Law§845-a) OCT 2 3 2019 S E C T 10 N I—REGISTRANT INFORMATION To be completed by the re istrant Last Name First Name MI Date of Birth Gender So abSa`tttafd u ty N m er o�irr�Ciet�g D Ct;d 7A��f L S- a�-y9 0 F 1 D 1 y o 15'31 / Home Residence Mailing Address City,State,Zip County of Home Residence 'CS' fi2&v-Aj '0�)II , M,17T/7-V C/C Home Residence Street Address(if Different) City,State,Zip City,State,Country of birth(if other than U S) lam the person named above. /understand that the information in Section I is part of a written statement that will be presented to the Division of Criminal Justice Services for filing,and I certify that it is true to the best of my knowledge and belief 1— L Date Signature I o- SECTION I I-AGENCY INFORMATION To be completed by the chief law enforcement officer 1 Last Nam First Name MI Title of Person Signing Section II SL A� v C'q s �t'14 Name of Law Enforc ment Agency Telephone — — OQ n-Iz `fie 112 6 3/ -7 3 �/' AddressCity,State,ZIP 2 Wo CPL§2.10 Subdivision CPL Title/Position of Registrant Weapons for(Circle All That Apply) NONE FIREARMS ASR BATON Type of Appointment Background Check Conducted Residency Verified Fingerpnnts submitted to DCJS Full-time Part-time Yes No Yes No Yes No I am the chief law enforcement officer responsible for appointing the person named in Section I as a peace officer of the above named law enforcement agency. I understand that the information in Section it is part of a written statement that will be presented to the Division of Criminal Justice Services for filing,and I certify that it is true to the best of my knowledge and belief !,td istand I am rAspAible for providing the registrant with the requisite training pursuant to CPL§2.30. Signature Date S E C T 10 N I I I—CIVIL SERVICE INFORMATION To be completed by the civil service officer for municl al and state registrants) me First Name MI Title of Person Signing Section III Name of Civil Service or Pers envy Telephone Address City,State, Title and Civil Service Classification of the Registrant I am the civil service officer responsible for c g tenhe appointment of individuals appearing on the payroll of the law ent agency named in Section If I understand that the information in Section 111 is a written statement that will be presented to the Division of Criminal Justice Services for rid 1 certify that it is true to the best of my knowledge and belie Signature Date S E C T 10 N I V—OATH OF OFFICE Public Officers Onl -To be completed by the registrar resporisible for recordin2 oaths of office Last Name First Name MI Title of Person Signing Section IV Q Na a of Recording Office �� Telephone 4 31— 73� &?e7 Address City,State,ZIP I am the officer responsible for recording the oaths of office of individuals appointed as peace officers of the law enforcement agency named in Section 11 The person named in Section I has filed an oath of office as a peace officer,pursuant to an appointment received from the person named in Section// I understand that the information in Section IV is part of a written statement that will be presented to the Division of Criminal Justice Services for filing,and I certify that it is true to the best of my knowledge and 'relief ;igna a Date Oath dmrnrs ered 0/Z� / COPYRIGHT©2007 NEW YORK STATE DIVISION OF CRIMINAL JUSTICE SERVICES(JAN 2007) rl3h6o