EMPLOYEE NAME (LAST, FIRST, MI)

CLASSIFICATION

POSITION NUMBER

DATE & TIME OF STATEMENT

RACE

SEX

DOB

DATE OF EMPLOYMENT

4 DIGIT ID NO.

DIVISION

SECTION

WATCH

I am	Investigator's Name

of the Atlanta Police Department	You are being questioned as a	TYPE STATUS

in an official investigation by the Department. Also present is:

All employees must answer questions and make available relevant materials or sworn statements concerning an investigation of allegations of employee misconduct when directed to do so by a disciplinary authority or duly appointed investigator. Employees may obtain representation but cannot delay questioning for more than three hours beyond the time he or she was notified of the questioning. Except as authorized or required, an employee shall not interfere with nor contact persons involved in an internal investigation nor disclose or discuss with anyone except the designated Departmental authority the existence or facts of an internal investigation. This restriction will not be construed to prohibit an employee from discussing any aspect of the investigation with his or her representative. Administrative statements made by employees and evidence gained by reasons of such statements may not be used against the employee in criminal proceedings involving the employee except in cases of perjury.

REPRESENTATIVES NAME:

All employees must answer questions and make available relevant materials or sworn statements concerning an investigation of allegations of employee misconduct when directed to do so by a disciplinary authority or duly appointed investigator. Employees may obtain representation but cannot delay questioning for more than three hours beyond the time he or she was notified of the questioning. Except as authorized or required, an employee shall not interfere with nor contact persons involved in an internal investigation nor disclose or discuss with anyone except the designated Departmental authority the existence or facts of an internal investigation. This restriction will not be construed to prohibit an employee from discussing any aspect of the investigation with his or her representative. Administrative statements made by employees and evidence gained by reasons of such statements may not be used against the employee in criminal proceedings involving the employee except in cases of perjury.

ATLANTA POLICE DEPARTMENT

EMPLOYEE STATEMENT

EMPLOYEE:	OPS #

I have read or had read to me the above statement and I swear or affirm that it is true to the best of my knowledge and belief.
EMPLOYEE SIGNATURE
Sworn and subscribed to me this
day of
in the year

PRINT EMPLOYEE NAME
NOTARY PUBLIC
P	-
-	1	-
Form APD826 revised 1/1/2000

EMPLOYEE NAME (LAST, FIRST, MI)

VWarnic

2001-07-13

Atlanta Police Department