AFFIDAVIT OF FACT
STATE OF ____________
COUNTY OF ________________
Before me, the undersigned authority in and for the State of ______________, on this day personally
appeared ___________________________________, who, after being by me duly sworn, deposed and
said:
My name is _______________________________. I am ______ years of age and my date of birth is
_____________________.
I affirm and attest to the following:
I am an applicant for the Police Communications Operator position with the Texas Department of Public
Safety and I am the person who took the CritiCall Public-Safety Dispatcher/Calltaker Pre-
Employment Test online.
I received no assistance in the completion of the CritiCall Public-Safety Dispatcher/Calltaker Pre-
Employment Test; doing so from another person or object constitutes cheating.
If conditions exist and I meet the requirements to continue in this application process, I will undergo
a pre-employment polygraph. If hired, and my lack of candor during the application process is
discovered, it is grounds for termination.
I declare under penalty of criminal prosecution and/or permanent disqualification from the TX DPS
Public Safety Communications Service application process, I have read the above statement consisting
of one (1) page, which is based on my personal knowledge, and it is true and correct.
__________________________________
Applicant Signature
(Must be signed in the presence of a notary)
Subscribed and sworn to before me, the undersigned authority, on this the ____ day of ____________,
A.D. ______.
__________________________________
Notary
CO-109 (07/2016)