ARIZONA GAME AND FISH DEPARTMENT BACKGROUND QUESTIONNAIRE

Transcription

1 ARIZONA GAME AND FISH DEPARTMENT BACKGROUND QUESTIONNAIRE FOR LAW ENFORCEMENT POSITIONS Applicant s Name: Position Applied For: TO THE APPLICANT: This questionnaire will be used for reference in conducting a background investigation into your personal history. Applicants will be required to take a polygraph examination to confirm the information in this questionnaire and in the AZPOST questionnaire and to determine and verify other background information items. Please refer to the Minimum Qualifications page on the Game and Fish employment website. Where written explanations are needed, it is MANDATORY that the information be explained TOTALLY AND COMPLETELY. Please make the explanations in the space below each question; use the continuation page (last page of this document) if necessary, referencing the applicable question. Please answer the following questions and provide detailed explanations (dates, times, etc.) if the answer is yes. SOCIAL MEDIA: Provide all social networking websites, including blogs and YouTube videos, you belong to. Include any and web addresses they are attached to: EMPLOYMENT HISTORY: 1) Have you ever failed to complete a probationary period for any job? 2) In any employment setting, including military service, have you received any verbal reprimands, written reprimands or suspensions for violation of company policy (military court martial, Article Fifteen, Captain s Mast)? 1

2 3) In any job that you ve held, have you been involved in any physical or verbal confrontation with cocoworkers, supervisors or customers? 4) Have you ever stolen anything or been accused or suspected of stealing anything from an employer or coworker? 5) Would you have any difficulty working or dealing with members of the opposite sex or people of a different race, religion or nationality? 6) Have you ever falsified employment records for personal gain (timecards, mileage, expense reports)? CRIMINAL HISTORY: 1) As an adult or juvenile, have you ever committed, participated in or witnessed any of the following? If yes, when and where? Homicide: Have you ever caused serious injury or death to any person? Assault: Kidnapping: Criminal Damage: Criminal Trespass: Disorderly Conduct: If yes, was a weapon involved? 2

3 Damaged or destroyed your property or property of another in anger: Robbery: Burglary: Theft: Shoplifting or changing price tags on merchandise: Bad check writing (knowingly): Forgery: Fraud (schemes, insurance claims): Bribery: Perjury: Impersonated a police officer or portrayed someone in a position of authority in violation of the law? Arson: False reporting: Carrying a concealed weapon (illegally): Possession or manufacturing of an illegal weapon: Possession, storage or manufacturing of illegal explosives: Game and Fish violation: Have you ever paid for a sex act? 3

4 Prostituting yourself or accepting payment or service for the commission of any sexual act: Sexual misconduct with a minor, you being the adult: Have you ever touched a child, or had a child touch you, for sexual reasons? Have you ever been the subject of an investigation by a child protective service (child welfare) agency? Have you ever engaged in a sex act with a person without their permission? Indecent exposure or masturbating in public even if you weren t seen: Have you ever engaged in any sex acts while on the job? Have you ever been involved in surreptitious viewing (peeping tom) or illicitly recorded activity? Have you ever engaged in a sex act with an animal? Have you committed injury to animals whether through inattention, neglect or intention? Have you ever shown pornographic material to a person under the age of 18 years old while you were an adult? 4

5 Have you ever viewed pornography of anyone under the age of 18? Have you ever viewed pornography at work? Falsification of any document (altered/fake ID): Have you ever contributed to the delinquency of a minor (e.g., alcohol, cigarettes, pornographic material)? Have you ever purchased, sold or obtained any property thought to be stolen? Have you ever been placed on court supervision or probation? Do you have any knowledge of any unreported or unsolved crimes? Have you ever committed a crime that was undetected for which you were not caught? NARCOTICS USE: 1) Have you ever forged a prescription? 5

6 2) Have you ever taken someone else s prescription medication: Type 1 st Time Last Time 3) Have you ever given anyone illegal drugs (prescription, marijuana, etc.)? Type of Drug 1 st Time Last Time 4) Have you ever contributed to the purchase of illegal narcotics? Type 1 st Time Last Time Max # Times $ Amt Contr Quantity ALCOHOL USE: Arizona Revised Statutes (A)(1) - Driving or Actual Physical Control While Under the Influence/Impaired to the Slightest Degree It is unlawful for a person to drive or be in actual physical control of a vehicle in this state while under the influence of intoxicating liquor, any drug, a vapor releasing substance containing a toxic substance, or any combination of liquor, drugs or vapor releasing substances if the person is impaired to the slightest degree. Law Enforcement Officers determine impaired to the slightest degree based on things like field sobriety tests, bloodshot-watery eyes, slurred speech, behavior, etc. 1) Based on the above description of impaired to the slightest degree, have you ever operated a motor vehicle while impaired by alcohol or drugs? 2) Have you ever been pulled over, arrested or convicted for DUI/OUI? 6

7 DOMESTIC VIOLENCE: 1) Have the police ever been called to your home for any domestic dispute situations? 2) Have the police been called to your home for any other reason (e.g., loud parties, alarms, barking dogs, etc.)? 3) Have you ever been verbally or physically abusive toward your spouse or children, relatives, boyfriends, girlfriends, parents or anyone else (pushing, shoving)? 4) Have you ever been convicted of any domestic violence offense, whether misdemeanor or felony? 5) Have you ever had a civil order placed against you (order of protection restraining order, injunction against harassment)? FINANCES: 1) Have you ever been delinquent on any of your financial obligations? Date Debt Total Balance Amt Past Due/X Mos/Yr Past Due 2) Have you ever had any of your financial obligations turned over to a collection agency? 7

8 3) Have you ever had any of your personal items repossessed? 4) Have you ever filed for bankruptcy? When? Where? Amount? Discharged? (Chapter 13-Voluntary, Chapter 11-Involuntary, Creditors)? 5) Have you ever failed to pay any court ordered payments or fines, including alimony or child support? 6) Has your pay ever been garnished? 7) Have you ever failed to file a tax return when required to do so? 8) Do you have any unresolved or outstanding I.R.S. obligations? 9) Have you had any lawsuits filed against you? If so please explain the circumstances, the result or status. MILITARY (for those with military experience): 1) Were there any special circumstances that caused you to leave the military prior to the end of your contracted tour of service? 2) Were you ever Unauthorized Absence (UA), Absent Without Leave (AWOL), missed formation or missed ship movement? 8

9 IMPORTANT FINAL QUESTION: Is there anything in your past that you have not told me about that may be discovered during a polygraph examination or during our background investigation? 9

10 CONTINUATION PAGE APPLICANT: 10