HomeMy WebLinkAbout52A - Form 10
Town of Lexington
Police Department
Chief Mark J. Corr
Notice of Employee Rights/ With Immunity
1575 MASSACHUSETTS AVENUE • LEXINGTON, MASSACHUSETTS 02420
781-862-1212/fax 781-863-1291
IA Form - 10
Employee name: _________________________________________ ID#: _______________
Today’s date: ________________ Time: _______________ Case#: ___________________
Interviewing officer: _________________________________________________________
Alleged misconduct: _________________________________________________________
1. The purpose of this interview is to elicit responses that will assist the Department in
determining whether the alleged misconduct occurred. This is an administrative
investigation relating to the official business of the Lexington Police Department.
2. You will be asked questions that relate directly, narrowly, and specifically to the
performance of your official duties as an employee of the Lexington Police Department.
3. Any answers that you may provide may be used against you in a disciplinary proceeding that
could result in administrative action against you, including dismissal.
4. If you are a member of a collective bargaining unit, you may request union representation
to be present if you reasonably believe that disciplinary action may result from this interview.
5. If you refuse to answer any question that is related directly, narrowly, and specifically to the
performance of your official duties as an employee of the Lexington Police Department, you
will be subject to the following disciplinary action: ________________________________
6. You are required to answer, even if you reasonably believe your answers could tend to
incriminate you, because you have received a promise, in letter form, from the offices of the
Attorney General and the District Attorney that you will not be prosecuted for any offenses
relating to the allegations about which you are being questioned.
7. If you do not understand any part of this notice, please ask for clarification immediately.
Receipt of Notice
The undersigned hereby acknowledges that he/she has been given proper notice of the
allegations and privileges provided above.
Employee Signature: ____________________________________ Date: _______________
Interviewer’s Signature: __________________________________ Date: _______________