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HomeMy WebLinkAboutVoegel, Christian W. OATH OF OFFICE FOR FIRE POLICE RECEIVED OCT 2 3 2019 STATE OF NEW YORK Woutriold Tauvn Clerk COUNTY OF SUFFOLK I, �,q 00f;y ( 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 604-e-�g✓f-- FIRE DEPARTMENT/COMPANY, ACCORDING TO THE BEST OF MY ABILITY. SIGNATURE �� ADDRESS CITY/STATE/ZIP SUBSCRIBED AND SWORN BEFORE ME THIS ) z V DAY OF OC�ge4 20 ► 7 LAWRENCE MICHAEL ZACARESE eTARY PUBLIC Notary�®02ZState of A6339303 w York Qualified in Suffolk County Commission Expires March 28,20 to RECEIVED New York State Division of Criminal Justice Services 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 registrant) Sots moi` �{ Last Name Flrs Name MI Date f Birth Ge de Social Security Number` v� -e-( �o�, U.f W lr 9G�3 F ®off-S'- Home Resl ence Mailing Address City,State,Zip County of Home Residence Home Residence Street Address(if Different) City,State,Zij30 I City,State,Country of birth(if other than U.S.) /am the person named above I understand that the information in Section/is part of a written statement that will be presented to the Division of Criminal Justice Services for filing,and 1 c rtdy that it is true to the best of my knowledge and belief. Signat Date (j S E C T 10 N I I—AGENCY INFORMATION To be completed by the chief law enforcement officer Last Name First Name MI Title of Person Signing Section II Name of Law Enforgement Agency Telephone Address City,State,ZIP 2(,v c\)C",,, 5 'Ao [V 2 d CL _kC110 i, ue rU ( I s CPL§2.10 Subdivision CPL Title/Position of Registrant Weaporys l icafor(Circle All That Apply) ON FIREARMS ASR BATON Type of Appointment Background Check Conducted Residency Verified Fingerprints 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 ofcer of the above named law enforcement agency. I understand that the information in Section II 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. Wnderstand I am resp Bible 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 INFORMA-ION To be completed by the civil service officer for munici al and state registrants) me First Name MI Title of Person Signing Section III Name of Civil Service or Pers ency Telephone Address City,State, Title and Civil Service Classification of the Registrant I am the civil service officer responsible for c g the appointment of individuals appeanng on the payroll of the law e—n7bfG<nent agency named in Section Il 1 understand that the information in Section Ill is a written statement that will be presented to the Division of Criminal Justice Services fo rid l certify that it is true to the best of my knowledge and bele Date Signature S E C T 10 N I V—OATH OF OFFICE Public Officers Only-To be completed by the registrar resporisible for recording oaths of office Last Name First Name MI Title of Person Signing Section IV -D rS Te-1 c,T cc' Name of Recording Office Telephone Address City,State,ZIP l am the officer responsible for recording the oaths of office of individuals appointed as peace officers of the law enforcement agency named in Section Il The person named in Section/has filed an oath of office as a peace officer,pursuant to an appointment received from the person named in Section II I understand that the information in Section iV is part of a written statement that will be presented to the Division of Cnminal Justice Services for filing,and 1 certify that it is true to the best of my knowledge and 'ielief signature GL Date Oath Administered COPYRIGHT©2007 NEw YORK STATE DIVISION OF CRIMINAL JUSTICE SERVICES(JAN 2007) rt3116o