1

BOLETIM DE INVESTIGAO SOCIAL

CONCURSO PBLICO PROVIMENTO 2013/1

PERITO CRIMINAL

NOME: _____________________________________________________

_____________________________________________________________

CIDADE DE RESIDNCIA: ______________________________

2

DADOS A SEREM PREENCHIDOS PELO CANDIDATO DE PRPRIO PUNHO

QUALIFICAO:

DADOS PESSOAIS (NO USE ABREVIATURAS):

NOME ________________________________________________________________________________________________________________

APELIDO(S)___________________________________________________________________________________________________________

DATA NASCIMENTO_______/_______/___________ SEXO_____________________ COR_________________________________________

FILIAO_____________________________________________________________________________________________________________

______________________________________________________________________________________________________________________

NATURALIDADE____________________________________________________________ ESTADO CIVIL____________________________

ENDEREO ATUAL____________________________________________________________________________________ N______________

COMPLEMENTO:_______________ CEP_____________________ BAIRRO ______________________________________________________

CIDADE _____________________________________________________________________________________________ UF ______________

TEMPO DE RESIDNCIA NA CIDADE ______________________ E NO ATUAL ENDEREO: ______________________________________

TELEFONES P/ CONTATO (_____) _________________________________ CELULAR (_____) ______________________________________

TELEFONE PARA RECADO (____) _______________________________________NOME___________________________________________

PROFISSO___________________________________________________________________________________________________________

CPF____________________________________ RG____________________________ RGO EXPEDIDOR ____________________________

TTULO DE ELEITOR____________________________________________________ ZONA _______________ SEO ___________________

CERT. DE RESERVISTA________________________________ CSM______________ RGO EXPEDIDOR. __________________________

N CARTEIRA DE HABILITAO ______________________________ CATEGORIA ________ RGO EXPEDIDOR __________________

CTPS_______________________N _____________SRIE____________________________________UF_______________________________

RESIDE EM IMVEL PRPRIO? ( ) NO ( ) SIM PAGA ALUGUEL? ( ) NO ( ) SIM VALOR? ______________________________

SE DE ALUGUEL EXISTE UMA IMOBILIRIA A QUE EST VINCULADO: ( ) SIM ( ) NO.

DIRETO COM O PROPRIETRIO? (NOME, ENDEREO E TELEFONE):_________________________________________________________

SE DE ALUGUEL FOR DIRETO, IDENTIFIQUE O PROPRIETRIO (NOME, RG, ENDEREO): _____________________________________

______________________________________________________________________________________________________________________

POSSUI DEPENDENTES? ( ) NO ( ) SIM / N DE DEPENDENTES_____________________________________________________

PARTICIPA DE ALGUMA COMUNIDADE VIRTUAL? ( ) NO ( ) SIM / QUAIS? _________________________________________

POSSUI SITE(S) OU BLOG(S), CASO AFIRMATIVO, IDENTIFIQUE:____________________________________________________________

______________________________________________________________________________________________________________________

E-MAIL(S): ____________________________________________________________________________________________________________

3

RESIDNCIAS ANTERIORES: (ltimos cinco anos)

A) ENDEREO__________________________________________________________________________________________N____________

COMPLEMENTO_______________ CEP______________________ BAIRRO ______________________________________________________

CIDADE ______________________________________________________________ UF ______ QUANDO TEMPO RESIDIU? _____________

B) ENDEREO_______________________________________________________________________________________N_______________

COMPLEMENTO_______________ CEP______________________ BAIRRO ______________________________________________________

CIDADE ______________________________________________________________ UF ______ QUANDO TEMPO RESIDIU? _____________

C) ENDEREO__________________________________________________________________________________________N____________

COMPLEMENTO_______________ CEP______________________ BAIRRO ______________________________________________________

CIDADE ______________________________________________________________ UF ______ QUANDO TEMPO RESIDIU? _____________

ESCOLARIDADE:

ESTABELECIMENTO CONCLUSO ENSINO MDIO________________________________________________________________________

______________________________________________________ ANO CONCLUSO ENSINO MDIO _________________ ENDEREO

COMPLETO/TELEFONE DO ESTABELECIMENTO ENSINO: _______________________________________________________________

_____________________________________________________________________TEL ( ) ___________________________________

ESTABELECIMENTO DE ENSINO DE CONCLUSO DO CURSO SUPERIOR ________________________________________________

GRADUAO________________________________________________________________________________________________________

( ) COMPLETO ( ) EM CURSO - MS E ANO DE CONCLUSO_______/ __________ENDEREO COMPLETO/TELEFONE DO

ESTABELECIMENTO ENSINO: ________________________________________________________________________________________

_____________________________________________________________________________ TEL ( ) ______________________________

EMPREGO ATUAL/LTIMO EMPREGO:

EMPRESA_____________________________________________________________________________________________________________

ENDEREO___________________________________________________________________N_________ COMPLEMENTO______________

BAIRRO _______________________________________________________________________________ CEP___________________________

CIDADE ____________________________________________________________________________________________ UF _______________

TEL (_____) __________________________ RENDA MENSAL ________________________ ADMITIDO __________/________/___________

FUNO ____________________________________________TEMPO NA FUNO _____________________________________________

CHEFE IMEDIATO (NOME, ENDEREO E TELEFONE DE CONTATO

EMPRESA_____________________________________________________________________________________________________________

ENDEREO___________________________________________________________________N_________ COMPLEMENTO______________

BAIRRO _______________________________________________________________________________ CEP___________________________

CIDADE ____________________________________________________________________________________________ UF _______________

TEL (_____) __________________________ RENDA MENSAL ________________________ ADMITIDO __________/________/___________

FUNO __________________________________________ TEMPO NA FUNO ________________________________________________

CHEFE IMEDIATO (NOME, ENDEREO E TELEFONE DE CONTATO_________________________________________________________

4

SENDO SERVIDOR PUBLICO OU EX-SERVIDOR PREENCHER:

RGO _______________________________________________________ SETOR ________________________________________________

CARGO ___________________________________________________________________ MATRICULA _______________________________

ESFERA ADMINISTRATIVA:__________________________________________________ TEMPO SERVIO: _________________________

(Federal, Estadual ou Municipal)

MOTIVO DA BAIXA, EXONERAO OU DEMISSO:_________________________________________________________

SENDO POLICIAL CIVIL, MILITAR, CORPO DE BOMBEIROS, GUARDA MUNICIPAL OU AGENTE

PENITENCIRIO OU EX-SERVIDOR DE UMA DESSAS INSTITUIES, PREENCHER:

SITUAO FUNCIONAL: ____________________________________________________ DATA DA NOMEAO ______/______/________

RGO _________________________________________________________________UNIDADE ____________________________________

ENDEREO_______________________________________________________________________________________________N__________

BAIRRO ________________________________________________CIDADE _________________________________________ UF __________

MATRCULA __________________________________ TEMPO DE SERVIO _________________ OPM______________________________

GRADUAO _____________________________________ N ________________ COMPORTAMENTO: _____________________________

MOTIVO DESLIGAMENTO ______________________________________________________________________________________________

RESPONDE ATUALMENTE OU J RESPONDEU A SINDICNCIA ADMINISTRATIVA E OU PROCESSO ADMINISTRATIVO?

( ) SIM ( ) NO DATA: MS____________/ANO_____________________________

MOTIVAO: _________________________________________________________________________________________________________

______________________________________________________________________________________________________________________

DESFECHO (CONCLUSO)______________________________________________________________________________________________

______________________________________________________________________________________________

SE TEM ARMA, PREENCHER:

N ARMA ____________________________________ CALIBRE _______________ MARCA ______________________________________

MODELO ___________________________________________ N REGISTRO JUNTO AO SINARM _________________________________

PARTICULAR ( ) SIM ( ) NO UNIDADE ________________________________________________________________

PROFISSIONAL LIBERAL OU OUTRAS:

PROFISSO ___________________________________________ TEMPO _______________ RETIRADA MENSAL____________________

ENDEREO _____________________________________________________________________________________ N _________________

BAIRRO_______________________________________________________________________ CEP__________________________________

CIDADE ______________________________________________________________ UF _______ TEL (______)________________________

PARTICIPAO EM EMPRESA(S):

EMPRESA ________________________________________________________________________ ENDEREO________________________

____________________________________________________________ BAIRRO ________________________________________________

5

CEP________________________ CIDADE CIDADE_____________________________________________________________ UF ________

CAPITAL ________________________________________________ GRAU / TIPO DE PARTICIPAO_____________________________

CARGO________________________________________________________________ RETIRADA MENSAL__________________________

PARTICIPAO EM EMPRESA(S):

EMPRESA ________________________________________________________________________ ENDEREO________________________

____________________________________________________________ BAIRRO ________________________________________________

CEP________________________ CIDADE CIDADE_____________________________________________________________ UF ________

CAPITAL ________________________________________________ GRAU / TIPO DE PARTICIPAO_____________________________

CARGO________________________________________________________________ RETIRADA MENSAL__________________________

BENS:

VECULOS (Se possui mais de um, relacionar ao final no espao destinado as informaes complementares)

POSSUI VECULO? __________ ANO___________ PLACA ________________ MODELO________________________________________

IMVEIS: (Se possui mais de um, relacionar ao final no espao destinado as informaes complementares)

LIVRE DE NUS? ________________ ESPCIE ___________________________________________ REA____________________________

ENDEREO________________________________________________________________________________________N_________________

COMPLEMENTO___________________ BAIRRO ____________________________________________________________________________

CIDADE ___________________________________________________________________________________________ UF ________________

DADOS DO CNJUGE OU CORRELATO (INCLUSIVE SE J SEPARADO):

NOME________________________________________________________________________________________________________________

RG_______________________________________CPF __________________________DATA DE NASC. ________/_________/________

PROFISSO_______________________________________________________________EMPREGADOR ______________________________

ENDEREO___________________________________________________________________________________________N______________

TEL (_____) __________________________ BAIRRO _________________________________________________________________________

CIDADE_______________________________________________________________ UF_________RENDA MENSAL____________________

FILHOS:

NOME_______________________________________________________________________________ DATA NASC. ______/______/________

NOME_______________________________________________________________________________ DATA NASC. ______/______/________

NOME_______________________________________________________________________________ DATA NASC. ______/______/________

NOME_______________________________________________________________________________ DATA NASC. ______/______/________

REFERNCIAS PESSOAIS: (EXCETO FAMILIARES ATE 2 GRAU DE CONSANGUINIDADE):

1) NOME______________________________________________________________________________________________________________

ENDEREO _______________________________________________________________________________________N __________________

COMPLEMENTO ________________ BAIRRO__________________________________________ TEL (____)___________________________

CIDADE________________________________________________________________________________________________ UF____________

6

2) NOME____________________________________________________________________________________________________________

ENDEREO _______________________________________________________________________________________N ________________

COMPLEMENTO ________________ BAIRRO__________________________________________ TEL (_____)________________________

CIDADE________________________________________________________________________________________________ UF__________

3) NOME____________________________________________________________________________________________________________

ENDEREO _______________________________________________________________________________________N ________________

COMPLEMENTO ________________ BAIRRO__________________________________________ TEL (_____)________________________

CIDADE________________________________________________________________________________________________ UF__________

ASSOCIAES OU AGREMIAES:

ASSOCIADO DE CLUBE E/OU AGREMIAO?? ( ) NO ( ) SIM

NOME_______________________________________________________________________________________________________________

ENDEREO _________________________________________________________________________________________________________

BAIRRO ______________________________________________________________________________ CEP__________________________

CIDADE________________________________________________________ UF_________ TEL (_____) _____________________________

SITUAO PROCESSUAL:

VOC J SE ENVOLVEU EM OCORRNCIA POLICIAL? EM QUE TIPO DE FATO? QUAL O SEU ENVOLVIMENTO? EM QUE ANO?

____________________________________________________________________________________________________________________

____________________________________________________________________________________________________________________

____________________________________________________________________________________________________________________

____________________________________________________________________________________________________________________

VOC J FOI PRESO/APREENDIDO? EM CASO POSITIVO, POR QUAL MOTIVO? ___________________________________________

____________________________________________________________________________________________________________________

____________________________________________________________________________________________________________________

VOC RESPONDE OU J RESPONDEU A INQURITO POLICIAL: ( ) SIM ( ) NO - COMARCA: __________________________

ESTADO: __________________ INDICIADO: ( ) SIM ( ) NO TIPIFICAO (ARTIGO):___________________________________

CONCLUSO:_______________________________________________________________________________________________________

VOC RESPONDE OU J RESPONDEU A PROCESSO: ( ) SIM ( ) NO

EM CASO AFIRMATIVO, INFORMAR ONDE ____________________________________________________________________________

QUANDO ________________ PORQUE? _________________________________________________________________________________

____________________________________________________________________________________________________________________

INFORMAES COMPLEMENTARES:

QUAL A SUA RELIGIO? _____________________________________________________________________________________________

FAZ USO DE MEDICAMENTOS CONTROLADOS? _____________QUAL? ____________________________________________________

PORQUE? ___________________________________________________________________________________________________________

J FEZ OU FAZ USO DE SUBSTNCIA TXICA: ( ) SIM ( ) NO

JUSTIFICATIVA:_____________________________________________________________________________________________________

____________________________________________________________________________________________________________________

7

POSSUI ALGUM VCIO? EM CASO POSITIVO, QUAL(IS)? ___________________________________________________________________

PORTADOR DE NECESSIDADES ESPECIAIS? EM CASO POSITIVO, QUAL(IS)? _______________________________________________

FALA OUTROS IDIOMAS? EM CASO POSITIVO, QUAl(IS)? _________________________________________________________________

QUAL(IS) SEUS HOBBY(ES)? ____________________________________________________________________________________________

POSSUI PARENTES EM CARGOS POLICIAIS OU NO SERVIO PBLICO? QUAIS? COMO PODEM SER CONTATADOS?

______________________________________________________________________________________________________________________

INFORMAES COMPLEMENTARES

DECLARO, SOB PENA DE RESPONSABILIDADE, QUE AS INFORMAES POR MIM PRESTADAS NESTE BOLETIM

SO VERDADEIRAS E QUE NO OMITI NENHUM DADO QUESTIONADO. DECLARO, OUTROSSIM, ESTAR CIENTE

DE QUE AS INFORMAES INVERDICAS PRESTADAS POR MIM, ENSEJARO A NULIDADE DA APROVAO E A

PERDA DOS DIREITOS DECORRENTES, SUJEITANDO-ME, AINDA, S SANES LEGAIS CABVEIS.

BELO HORIZONTE, ______DE_______________________DE_____________

_____________________________________________________________________ ASSINATURA DO CANDIDATO

SOMENTE NA PRESENA DO SERVIDOR DA ACADEPOL NA DATA DA ENTREGA