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<br />Town of Lexington <br />Police Department <br />Chief Mark J. Corr <br /> <br />Notice of Employee Rights/ With Immunity <br /> <br />1575 MASSACHUSETTS AVENUE • LEXINGTON, MASSACHUSETTS 02420 <br />781-862-1212/fax 781-863-1291 <br />IA Form - 10 <br /> <br /> <br />Employee name: _________________________________________ ID#: _______________ <br /> <br />Today’s date: ________________ Time: _______________ Case#: ___________________ <br /> <br />Interviewing officer: _________________________________________________________ <br /> <br />Alleged misconduct: _________________________________________________________ <br /> <br />1. The purpose of this interview is to elicit responses that will assist the Department in <br />determining whether the alleged misconduct occurred. This is an administrative <br />investigation relating to the official business of the Lexington Police Department. <br /> <br />2. You will be asked questions that relate directly, narrowly, and specifically to the <br />performance of your official duties as an employee of the Lexington Police Department. <br /> <br />3. Any answers that you may provide may be used against you in a disciplinary proceeding that <br />could result in administrative action against you, including dismissal. <br /> <br />4. If you are a member of a collective bargaining unit, you may request union representation <br />to be present if you reasonably believe that disciplinary action may result from this interview. <br /> <br />5. If you refuse to answer any question that is related directly, narrowly, and specifically to the <br />performance of your official duties as an employee of the Lexington Police Department, you <br />will be subject to the following disciplinary action: ________________________________ <br /> <br />6. You are required to answer, even if you reasonably believe your answers could tend to <br />incriminate you, because you have received a promise, in letter form, from the offices of the <br />Attorney General and the District Attorney that you will not be prosecuted for any offenses <br />relating to the allegations about which you are being questioned. <br /> <br />7. If you do not understand any part of this notice, please ask for clarification immediately. <br /> <br /> <br />Receipt of Notice <br /> <br />The undersigned hereby acknowledges that he/she has been given proper notice of the <br />allegations and privileges provided above. <br /> <br />Employee Signature: ____________________________________ Date: _______________ <br /> <br />Interviewer’s Signature: __________________________________ Date: _______________