GARRITY WARNING
Date and Time: ____________________

Place:____________________________

Interviewer:_______________________
         This questioning concerns administrative matters relating to the official business

of the_________________________Police. I am not questioning you for the purpose of

instituting a criminal prosecution against you, or for the purpose of  securing  additional

evidence  against  you  in  any  pending  criminal  action.  During  the   course  of  this

questioning, even  if  you  disclose  information  which  indicates  you may be guilty of

criminal conduct concerning this allegation, neither your self-incriminating statement or

its  fruits  will   be  used    against you   in  a   criminal   proceeding.     Since this is an

administrative  matter  within the _____________________________Police,  you    are

required to answer  questions  truthfully   and   completly or  you  may  be subjected to
administrative action.



Do you understand what I have just explained to you?

______Yes               ________No


Do you have any questions concerning what I have just explained to you?

______Yes                 _______No


______________________________________

Signature of Witness

______________________________________

Signature of Witness

                                                                         _____________________________
                                                                             
                                                                         Signature of Employee  
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