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CHP – Pre-Investigation Questionnaire

CHP – Pre-Investigation Questionnaire

 

Pre-Investigative Questionnaire (v2)

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Candidate Details

Candidate Name*

Terms

As an applicant for a position with a Public Safety Agency, I am required to complete this Pre-Investigative Questionnaire. I am admonished that any false statement or omission on this questionnaire may cause my name to be removed from the eligibility list or be considered for immediate dismissal if an appointment is made.
Do you understand this statement?*
Do you have any questions about this admonishment?*
MM slash DD slash YYYY
Read and answer the following questions carefully and honestly. A “Yes” answer may not, in and of itself, be grounds for disqualification or non-selection, whereas an untruthful response could be. Answers may also be subject to verification by a polygraph examination and / or medical examination, including but not limited to, a drug screening. ALL questions answered “Yes” require an explanation. All questions must be answered completely, accurately, and truthfully. If the incident has occurred more than once, make sure you explain all occurrences.

The questions are used to help assess your personality traits, past behavior, integrity, interpersonal skills, decision-making abilities, and overall suitability for the position. For this reason, in addition to being evaluated on your moral character and suitability, you will also be evaluated on your ability to complete this questionnaire accurately. Part of the assessment is your ability to follow instructions properly.

PERSONAL

Are you known by, or have you used, any other name, moniker or aliases?*
Are you concerned that you may not meet one or more of the minimum qualifications?*
Have you any concerns about an investigation into your background?*
Have you ever been reported as a runaway or missing person?*
Have you ever been detained by a law enforcement agency for a mental illness?*
Are you afraid of physical combat?*
Have you ever legally changed your name?*
Have you ever used any other social security number?*
Do you use another mailing address? (Residential, Commercial, P.O. Box)?*
Did you tell any of your personal references, coworkers, or supervisors what to say, or what to NOT say, if contacted by background investigators?*
Have you ever viewed any websites or read any materials that describe how to beat or fool a polygraph or voice stress examination?*
Have you ever engaged in civil disobedience?*
Have you ever been listed in a police report as a victim, witness, lead, or suspect?*
Did you threaten any of your co-workers, supervisors, references, neighbors, or roommates/housemates, past or present, regarding potentially harmful information they might reveal?*
Do you claim dual citizenship, or nationality, with the United States and any other country?*
Have you ever attempted suicide or intentionally harmed yourself?*
Have you ever participated in a protest or demonstration of any kind?*
Have you ever told a serious lie to someone in authority?*
Has the fact that you want this job caused any conflict with your family or friends?*
Do you currently use more than one email address?*
Have you ever visited an inmate in a jail, prison, or other custodial facility?*

SOCIAL MEDIA / INTERNET

Do you have, or have you ever been a member of a computer social networking or social media site including Facebook, Twitter, X, LinkedIn, Instagram, TicTok, or any other social site?*
Common platforms include (but are not limited to): Facebook. Instagram, LinkedIn, TikTok, Reddit*
Platform Name
Is the account active?
Link to Public Profile
Public Profile Name
 
Have you ever viewed or posted on an online message board or online forum?*
Common platforms include (but are not limited to): Facebook. Instagram, LinkedIn, TikTok, Reddit*
Platform Name
Is the account active?
Link to Public Profile
Public Profile Name
 
Do you have any social networking accounts under a different name or identity?*
Common platforms include (but are not limited to): Facebook. Instagram, LinkedIn, TikTok, Reddit*
Platform Name
Is the account active?
Link to Public Profile
Public Profile Name
 
Have you currently have or ever had a blog or participated in blogging website(s)?*
Common platforms include (but are not limited to): Facebook. Instagram, LinkedIn, TikTok, Reddit*
Platform Name
Is the account active?
Link to Public Profile
Public Profile Name
 
Have you ever used a cyber aliases, nicknames, or monikers on social media or the internet?*
Enter all cyber aliases, nicknames, or monikers you have ever used on social media or the internet*
Aliases / Nickname
Platform used on
Is the account active?
Link to Public Profile
Public Profile Name
 
Have you ever posted a video on YouTube or another video site?*
Common platforms include (but are not limited to): Facebook. Instagram, LinkedIn, TikTok, Reddit*
Platform Name
Is the account active?
Link to Public Profile
Public Profile Name
 
Will a search of the internet find any content that you are associated with that may be concerning?*
Common platforms include (but are not limited to): Facebook. Instagram, LinkedIn, TikTok, Reddit*
Platform Name
Link to Public Content
 
Have you ever accessed someone else's password-protected account without consent or knowledge, including e-mail, Facebook, MySpace, Twitter, iTunes, Linkedin, etc?*
In the last 5 years, have you deleted or deactivated any of your social media accounts?*
In the last 5 years, have you deleted any posts or photos on any of your social media accounts because you thought they might reflect poorly upon you during the background process?*
Did you change the status of any of your social media accounts to be restricted in any way because you thought they might reflect poorly upon you during the background process?*
Have you ever used social media or the Internet to obtain information for the purposes of committing a crime or illegal act?*
Have you ever used the Internet or Social Media to taunt, harass, intimidate, or otherwise annoy another person?*
Will any of your references, employers or anyone else tell us about any areas of concerns with your use of social media or the internet?*

RELATIVES & REFERENCES

Might someone tell us you have a personality characteristic that is unsuitable for public safety employment (i.e., violent temper, violent tendencies or suicidal tendencies)?*
Might someone tell us you are not always honest or that you tend to be less than truthful?*
Might someone tell us you do not always treat some people fairly or impartially?*
Might someone tell us you lack the interpersonal skills to work in Public Safety?*
Might someone tell us you are unable to physically handle the position?*
Might someone tell us you tend to manipulate people to get what you want?*
Might someone tell us that you have a prejudice or bias toward minority groups or certain types of people?*
Might someone tell us that you tend to be discourteous, impolite, disrespectful, or rude to people?*
Might a current or past supervisor not recommend you for a position of public trust?*
Might a relative, or other reference, give you an unfavorable recommendation?*
Might a former spouse or significant other give you an unfavorable recommendation?*
Have you lived or do you live, with friends or family members that have served time in any prison or jail facility?*
Might someone tell us that you tend to be offensive, vulgar, bad mannered, or uncouth to others?*
Did you ask or tell any of your personal references to lie or omit information about your personal life?*
Have you had a past romantic relationship (either serious or casual) since the age of 16?*
List all of your current and past romantic relationships, both serious and casual, that you have had since the age of 16. Do not include your current spouse or former spouses.*
First Name
Last Name
Email Address
Phone Number
Date of Relationship (From-to)
 

EDUCATION

Have you ever cheated on any college examination or test?*
Have you ever cheated on any high school examination or test?*
Have you ever cheated on a performance examination, including a physical abilities test?*
Have you ever altered, falsified, counterfeited, or forged any school record, application, or school transcript?*
Will any teacher or other school official tell us you had behavioral problems while attending any school?*
Have you ever taken a concealed firearm or weapon to any public/private school or on any college campus?*
Have you ever threatened any teacher, school official or other staff member with violence?*
Have you ever hit, struck, pushed, or injured any teacher, school official or staff member?*
Have you ever been suspended or expelled from any private or public school or college?*
Have you ever called in a bomb threat to any school or college?*
Have you ever been involved in any physical fights in high school or college?*
Have you ever failed or dropped out of any law enforcement academy or training class?*
Have you ever had any contact with campus police?*
Have you ever been academically dismissed?*
Have you been investigated in school for plagiarism or cheating?*
Have you ever been placed on academic or athletic probation?*

RESIDENCE

Do you have any problems getting along with any of your current or past neighbors?*
Have you any reason to be concerned about an investigation into the places you have lived?*
Are you currently living with a convicted felon or with someone who is on parole from prison?*
Are you currently living with someone who is committing crimes?*
Are you currently living with someone who is a registered sex offender?*
Are you currently living with someone with violent tendencies?*
Are you currently living with someone who has committed a hate crime?*
Have you ever been threatened with eviction or been evicted?*
Has anyone complained to police about any activity or commotion at your home?*
Have you ever allowed someone to keep, store or hide stolen property at your home, garage or property?*
Have you ever been asked to leave a residence because of your temper or argumentative behavior?*
Have you ever allowed someone running from the police or other authorities to stay at your residence including juvenile runaways and wanted persons?*
Have the police or a law enforcement officer visited your home for the purpose of investigating a crime or to ask you or any member of your household questions about a crime?*
Has anyone in your household ever been arrested?*

RESIDENCE (continued)

Have the police been to your home to investigate a disturbance or loud argument?*
Have you ever forced a family member out of your home?*
Have you ever had a party at your residence where the neighbors complained about the noise?*
Have you had a party at your residence where illegal drugs were being used?*
Do you own any other properties other than your primary residence?*
Have you ever been late paying rent or failed to pay rent at any current or former residences?*
Have you ever moved to avoid paying rent?*
Have you ever left any residence under unfavorable circumstances?*
Have you ever been evicted, threatened with eviction, or served a 3-day notice to “Pay or Quit”?*
Have you lived at a residence that has gone through foreclosure proceedings?*
Have you ever damaged or removed household items from a foreclosure residence you were vacating?*
Have you ever lived at a property where you were not listed on the lease as required?*
Are you currently or have you ever lived with a person who was, or is, wanted for questioning by law enforcement about any crime?*
Have you ever left a residence owing utilities, rent, or other household expenses?*

EXPERIENCE & EMPLOYMENT

Have you reason to be concerned about an investigation into your work history?*
Is anyone likely to report derogatory information about your work history or work performance?*
Would any past employer decline to rehire you because of your behavior, conduct, or attitude?*
Have you ever committed a dishonest, immoral act to obtain a job, promotion, transfer, or higher performance rating?*
Have you ever done anything improper, that if caught, you would be fired or suspended?*
Have you ever been found to be in violation of any law, regulation or work policy involving discrimination, sexual harassment, or workplace violence?*
Have you ever used your title, position, rank, or company status to gain sexual favors?*
Have you ever been disciplined, suspended, or fired for losing your temper, or becoming hostile?*
Have you ever been disciplined, suspended, or fired for insubordination, defiance, or noncompliance?*
Have you ever been in a physical fight, hostile confrontation or loud argument with a supervisor, co-worker, or client/customer?*
Have you ever left a job with hard feelings toward the management, supervisors, or co-workers?*
Have you ever made a false allegation or false complaint against a supervisor, manager or director or co-worker?*
Have you ever been disciplined, suspended, or fired for lying or being untruthful?*
Has a citizen or customer complained to your employer about your attitude or behavior?*
Have you ever caused an injury to someone at work by your improper behavior?*
Have you ever counterfeited, forged, or dishonestly altered a timecard or time sheet to gain more money?*
Have you ever lied, made-up, fabricated, or misrepresented work hours or overtime?*
As an employee have you ever intentionally falsified a receipt, voucher, sales slip, or invoice?*
Have you ever stolen money from any employer?*
Have you ever stolen any property, equipment or material valued over $10 from an employer or kept extra pay you did not earn?*
Have you ever taken property, equipment or material from an employer and never returned it?*
Have you ever intentionally damaged property or equipment belonging to an employer or co-worker?*
Have you ever used any illegal narcotic during work hours or just prior to going to work?*

EXPERIENCE & EMPLOYMENT (continued)

Have you ever engaged in, participated in, or not reported, acts of racism or discrimination toward any supervisor, coworker, or client/customer?*
Have you participated in or not reported acts of sexual harassment or hazing toward any supervisor, coworker, or client/customer?*
Have you ever filed a bogus, false, or fictitious work injury report or filed a false workers compensation claim?*
Have you ever used a company computer to obtain restricted or unauthorized information for personal gain or for someone else?*
Have you ever intentionally deleted, altered, or destroyed company records to cause harm or disruption?*
Have you ever used a company computer to view unauthorized or prohibited websites on the Internet?*
Have you ever used a company computer to view restricted confidential records for personal reasons?*
Have you ever planted a computer virus with the intent of destroying company records or documents?*
Have you ever “called-in sick” when you were really well and not taking care of a sick family member?*
Has any supervisor, director, or employer ever spoken to you about being tardy or absent too often?*
Have you ever abandoned, quit, or left a job without giving proper two-week notice?*
Have you ever been fired from a job, released from probation, or asked to resign in lieu of termination?*
Has a bonding company ever turned you down?*
Have you ever been disciplined at work for any reason?*
Have you ever been found to be untruthful during a polygraph examination or voice stress analysis test?*
Have you ever falsified, withheld, or omitted information on any employment application?*
Have you ever received a verbal reprimand from any employer?*
Might a current or past supervisor or co-worker not recommend you?*
Have you ever received a written reprimand from any employer?*
Have you ever been counseled by any employer?*
Have you ever been charged disciplinary points in a point-based disciplinary system?*
Have you ever been disciplined, suspended, or fired from an employer for theft?*

EXPERIENCE & EMPLOYMENT (continued)

Have you ever been threatened with consequences, at work, for failure to complete work as directed?*
Have you ever been forced to or asked to resign from any employment?*
Have you ever been released during probation from any employment?*
Have you ever received an evaluation that was rated below standards or needs improvement?*
Have you ever engaged in any type or sexual activities (including masturbation) while at work or on company time?*
Have you ever been fired, terminated, laid off, or suspended from any employment?*
Is your version of how you left a job likely to differ from that of your employers?*
Have you ever had a complaint filed against you by a supervisor or coworker?*
Have you ever given a proper two-week notice but didn’t serve it out?*
Have you ever left a place of employment under unfavorable conditions?*
Have you ever abandoned, quit, or left a place of work to avoid being fired or suspended?*
Have you ever been investigated by an employer for improper conduct or illegal activity?*
Have you ever filed for or received unemployment benefits?*
Have you ever worked “under the table” for cash?*
Have you ever filed for or received workers compensation for a work-related injury that you were not entitled to?*
Have you ever caused an injury to another at work by your improper behavior?*
Have you ever counterfeited, forged, or dishonestly altered a timecard or time sheet to gain more money or non-monetary benefits?*

EXPERIENCE & EMPLOYMENT (continued)

Have you ever received pay you did not earn and kept it without reporting it?*
Have you ever operated your own business without properly obtaining a business license?*
Have you ever operated your own business without reporting your income on your tax return?*
As an employee, have you ever intentionally falsified a receipt, voucher, sales slip, or invoice?*
Have you ever intentionally falsified a warranty or service contract?*
Have you ever stolen money (cash, coins, checks, receipts, voucher, gift cards) from an employer or coworker (including from a cash drawer, box, register, or safe)?*
Have you ever been late to work?*
Have you ever allowed others to steal items, or cash, from any of your places of employment?*
Have you ever given away items from an employer without authorization?*
Have you ever reduced the cost of an item at work without authorization?*
Have you ever consumed alcoholic beverages at work or within six hours prior to scheduled work hours?*
Have you ever tested positive for an employment related drug test?*
Have you ever worked while under the influence of drugs (prescription or illegal) or alcohol?*
Have you ever returned to work from a break or lunch after consuming one or more alcoholic beverages?*
Have you ever used any illegal narcotic during work hours or within six hours prior to scheduled work hours?*
Have you ever provided confidential information from your employer to any unauthorized person?*
Have you ever had any extended work absences for any reason other than for medical or earned vacation?*
Have you ever been asked to resign or leave a volunteer or unpaid position?*
Have you ever retired, or resigned, to avoid investigation, prosecution, or discipline?*

EXPERIENCE & EMPLOYMENT – OTHER AGENCY APPLICATIONS

Have you ever previously applied to this agency, or any other, for a sworn and / or a civilian position?*
Agency*
Agency
Date Applied
Current Status
Position
Investigator
 
Have you ever applied to another government agency not listed on the previous question? This include any Police, Fire, Medical, Ambulance, or other Public Saftey Agency.*
Agency*
Agency
Date Applied
Current Status
Position
Investigator
 
Have you ever been disqualified by this agency, or any other public safety agency for any reason?*
Have you ever worked for any public safety agency in any capacity?*
Have you ever withdrawn, waived or discontinued your application to a public safety agency because you knew or suspected that you were going to be non-selected or disqualified after you applied?*
Have you ever been rejected as a public safety candidate for intentionally lying, withholding information, or trying to deceive the agency?*
Have you ever been disqualified as a public safety candidate due to drug related issues?*
Have you ever been disqualified as a public safety candidate due to issues related to criminal activity?*
Have you ever worked for any fire department, EMS agency, and/or Ambulance Service in any capacity?*

MILITARY

Have you ever attempted to enlist in any military organization in this country or another?*
Have you ever been rejected or turned down by any military organization?*
Did you fail to register with the selective service as required (for men) at 18?*
Have you ever served in any military organization in this country?*
Organization*
Have you ever served in any military organization in another country?*
Country*
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Have you ever served in any military organization in this country or another?*
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Answer questions if you served in the military
Did you receive a discharge type that was not “Honorable?"*
Do you have any concern about an investigation into your activities or performance while in the military?*
If already discharged, and not retired, would the military decline you if you attempted to re-enlist?*
Did you ever receive a court martial?*
While in the military did you receive judicial punishment including written reprimands?*
While in the military did you receive any non-judicial punishment?*
Were you ever restricted to base as punishment for an improper act you committed?*
Were you ever placed in military confinement or place under military arrest or detention?*
Were you ever reduced in grade or rank?*
Were you ever denied any type of security clearance?*
Did you ever use your position or rank in the military to gain sexual favors?*
Did you ever obtain classified information in an unauthorized manner?*
Did you ever participate or engage in racial or sexual discrimination in the military?*
Were you ever AWOL?*
Were you ever investigated by INS, Department of Defense, FBI, or military police for any illegal activity?*
Did you ever try, use, or experiment, any illegal drug or narcotic on or off a base?*
Did you ever disrespect a superior officer by refusing to follow a lawful order or command?*
Did you ever steal, take, or keep military property without permission for personal use or to sell or give away?*
Did you ever cause injury to another person in the military due to negligence or carelessness?*
While in the military, did you ever do something that you knew was against military regulations that if caught you would be discharged or disciplined?*
Have you ever used deadly force while in the military?*
Have you ever served as a military police officer?*
Were you ever arrested, detained, or taken into custody by the military police?*
Were you ever contacted, questioned, or stopped by the military police or base security for inappropriate actions including traffic citations?*
Did you ever have, even temporarily, a security clearance revoked, suspended, or downgraded?*
Have you ever taken souvenirs from a combat environment and kept them for novelty?*

FINANCIAL

Have you ever filed or declared bankruptcy?*
Have you ever had your wages attached or garnished?*
Have you had a debt, account or loan turned over to a collection agency?*
Have you ever been delinquent or late on income taxes or other taxes?*
Are you now or have you ever been on a payment plan for paying any taxes, liens, or other judgments?*
Have you ever skipped out on any debt or financial obligation?*
Have you ever skipped out on paying rent by moving away?*
Have you ever used false information to apply for any credit?*
Have you ever intentionally filed a fictitious, false, or untrue tax return?*
Have you ever intentionally written a bad check?*
Have you ever taken money or benefits from a city, county, or federal government under false pretenses?*
Have you ever obtained and/or used a credit card, ATM card, debit card or check card illegally?*
Have you been late on child support payments?*
Have you ever opened a checking account, using a phony name or address?*
Have you ever borrowed money from a friend or relative with no intent of paying them back?*
Have you ever provided false information about your identity on a credit or loan application?*
Have you ever avoided paying any debt by moving away, changing your name or social security number?*
Have you ever been refused or skipped out on paying a student loan?*
Have you ever attempted or obtained financial gain through dishonest means or illegal acts?*
Have you ever collected unemployment benefits that you were not entitled to or through dishonest means or filed a false unemployment claim?*
Have you ever filed a false insurance claim to collect money or property?*
Have you ever loaned money to someone and threatened violence if they did not pay you?*
Have you ever borrowed money to pay a gambling debt?*
Have you ever participated in or took part in illegal gambling?*
Have you ever placed a bet on a sporting event for someone?*

FINANCIAL (continued)

Have you ever gambled with your income or savings while delinquent or behind on your financial obligations?*
Have you ever sold or bought a fictitious ATM, debit, or credit card?*
Have you ever been involved in money fraud or counterfeiting?*
Have you ever used a false, phony, or different social security number for any reason?*
Have you ever had a poor credit rating or credit report?*
Have you ever been sued over a debt?*
During your background is anyone likely to report that you have financial issues or do not manage your finances well?*
Have you ever filed or collected a false welfare or government assistance claim with any private or public organization?*
Have you ever had any property repossessed?*
Are there any civil actions pending in civil court in which you are a defendant?*
Do you currently have, or have you ever had any lien or judgment filed against you, your property, or any business of yours?*
Have you ever been delinquent or late on any of your monthly bills?*
Have you ever been late paying your rent or mortgage?*
Have you ever collected welfare?*
Have you ever collected food stamps?*
Have you ever had a government subsidized educational loan that became delinquent?*
Have you ever purposely avoided paying any debt or financial obligation?*
Are you currently required to pay court ordered restitution?*
Have you ever failed to make or been late on a court ordered payment (child support, alimony, restitution)?*
Have you ever refused to pay a court ordered payment (child support, alimony, restitution)?*
Have you ever attempted or committed fraud against a financial institution or bank?*
Are you delinquent or late on any of your credit card, loan, and/or revolving account payments?*
Have you ever been late with your credit card, loan, and/or revolving account payments?*
Have you ever failed to file an income tax return?*
Have you ever been investigated for filing a false tax return?*
Have you ever had all or part of your federal or state tax return withheld for any reason?*
Have you bought or sold an ATM, Debit, or Credit card that was in someone else's name?*

LEGAL

Have you ever been charged with a felony where the conviction was reduced to a lesser crime?*
Have you ever been charged with a misdemeanor where the conviction was reduced to a lesser crime?*
Have you ever been taken to a jail or a police holding room?*
Have you ever received a misdemeanor citation? (Citation in lieu of being booked)*
Have you ever been charged, arrested, or detained in another country?*
Have you ever been detained at a U.S. border for suspected illegal activity?*
Have you ever been charged, arrested, or detained for a hate crime?*
Have you ever committed a hate crime even if not caught?*
Have you ever been with someone who committed a hate crime?*
Are you ever engaged in or are you currently engaging in membership in a hate group, participating in any hate group activities, or advocate public expression of hate?*
Have you ever belonged to, or associated with, a subversive or militant group, alliance or organization that advocates racism or hatred toward others because of their way of life, background, culture, or customs?*
Have you ever delivered, sent, transmitted, disseminated, or mailed flyers, letters, bulletins, books, notices, photos, literature of any kind or electonically transmit to anyone containing racist or sexist information?*
Have you belonged, associated, or subscribed to any subversive or militant group or organization that advocates the use of aggression toward the U.S. Federal Government, state government or city government?*
Have you associated with someone, a group, alliance, association, club, or organization that despised certain cultures or types of people?*
Have you ever hit, struck, slapped, kicked, pushed, thrown or grabbed your spouse, girlfriend, boyfriend or significant other in anger or while involved in an argument at home or in public?*
Have you ever prevented or prohibited someone from making an emergency telephone call?*
Have you ever had a restraining order filed against you?*
Have you ever committed a violent assault upon another person (including spouse, significant others)?*
Have you ever struck, kicked, or injured someone living with you?*
Have you ever been a suspect, victim or witness to domestic violence?*
Have you ever lost your temper with your family, friends, co-workers, supervisors, or a stranger?*
Have you ever followed someone against their will, or stalked someone by following them secretly, furtively, or surreptitiously? (Stranger, someone you know, public figure or entertainer)*
Have you ever encouraged someone to lie to a law enforcement officer or lie while testifying in court?*

LEGAL (continued)

Have you ever knowingly filed a fictitious or false police report?*
Have you ever called in a false emergency to the police or fire department?*
Have you ever called a police or fire dispatcher and lied about your identity?*
Have you ever offered a bribe to a police officer, deputy sheriff, law enforcement officer or public official?*
Have you ever intentionally given false information to any police officer or other law enforcement officer?*
Have you ever lied or given false information to a court official, City Attorney, District Attorney or Judge?*
Have you ever lied while testifying in court?*
Have you ever threatened force or violence against a spouse, former spouse, relative, girlfriend, boyfriend, or anyone, including a stranger, who was going to be interviewed by the police or testify in court?*
Have you ever falsified or planted any evidence before, during or after a criminal or civil investigation?*
Have you ever threatened force or violence or attempted to intimidate a person serving on a jury?*
Have you injured or threatened to cause harm or injury to any law enforcement officer?*
Have you ever run from any police officer or law enforcement official?*
Have you ever resisted arrest or fought with a police officer, or law enforcement officer?*
Have you ever assisted someone to escape from police custody, detention or jail?*
Have you ever protected a person or fugitive from arrest or questioning?*
Have you ever covered-up a crime or mislead any public official for someone?*
Have you ever pretended to be a law enforcement officer with the intent of misleading someone in order to obtain personal information or confidential information?*
Have you ever pretended to be a law enforcement officer with the intent of misleading someone in order to detain, confine, restrict, arrest or scare someone?*
Have you ever blackmailed someone? (Forced someone to do something because you had knowledge or leverage that could embarrass them or get them in trouble)*
Have you ever modified or equipped your vehicle to represent an emergency vehicle to mislead someone?*
Have you ever been accused of, or questioned about child abuse, child neglect or child molestation?*
Have you ever injured or bruised a child because of losing your temper or by using corporal punishment?*

LEGAL (continued)

Have you ever ignored someone committing what you thought was child abuse, neglect, or molestation?*
Have you ever tied up a child, or locked up a child in a small, confined space to discipline the child?*
Have you ever disciplined a child by placing a child into a dangerous or unsafe situation where the child could be injured or hurt because of losing your temper or administering discipline?*
Have you ever left or abandoned a child or children without proper care or proper supervision?*
Have you ever used your child or children as leverage to force the other parent to do something against their will?*
Have you ever taken your child or children against the will of the other parent?*
Have you ever violated a child custody court order?*
Have you ever refused or intentionally delayed your obligation to pay child support?*
Have you ever falsified any school record regarding the identity of your child or children?*
Have you ever been involved in a physical fight with someone?*
Have you ever assaulted someone in anger using a bat, club, stick, pipe, or other hard object?*
Have you ever used a knife, dagger, or other stabbing instrument against someone in anger or defense?*
Have you ever brandished or pointed a firearm in a threatening or rude angry manner at someone?*
Have you ever fired a firearm illegally at a house, building, apartment, vehicle, vessel or aircraft?*
Have you ever fired a firearm at someone or used it to scare or intimidate them?*
Have you ever carried a concealed firearm on your person without a lawful permit?*
Have you ever been in a vehicle where someone else discharged a firearm?*
Have you ever purchased, constructed, or attempted to construct a bomb or explosive?*
Have you ever associated a person, or group of persons, who constructed a bomb or explosive?*
Have you ever been a gang member or associated with gang members?*
Do you currently have any friends, family members or associates that are currently gang members?*
Do you currently have or ever had any gang tattoos or monikers?*
Have you ever assisted or cover up any crime committed by a gang member.*
Have you ever committed any graffiti, tagging, or similar act?*
Have you ever stolen money? (Cash, money orders, checks, bank notes, etc.)*

LEGAL (continued)

Have you ever stolen electronic equipment? (TV’s, stereo’s, computers, cellphone, etc)*
Have you ever stolen a purse, wallet, briefcase, jewelry, suitcase, or similar items?*
Have you ever bought, maintained, or kept property, knowing or believing it was stolen or illegally obtained?*
Have you ever stolen money? (Cash, money orders, checks, bank notes, etc.)*
Have you ever committed a theft by using a mask or disguise or by using a weapon?*
Have you ever stolen a vehicle or taken a vehicle without the owner’s permission?*
Have you ever associated with or been a member of a street racing club or outlaw motorcycle club / gang?*
Have you ever kept a vehicle longer than was agreed to, without the owner’s permission?*
Have you ever committed a theft by taking an item directly from a person?*
Have you ever committed a theft by breaking into a car or taking something from an open or unlocked car?*
Have you ever stolen car parts?*
Have you ever committed shoplifting, including the switching of price tags or not scanning items at self checkout?*
Have you ever entered a house, garage, building, or other dwelling to commit a theft?*
Have you ever used a weapon, applied force or fear, to steal something from someone?*
Have you ever made harassing, annoying, or threatening telephone calls to anyone?*
Have you ever had to testify in a criminal or civil proceeding?*
Have you ever had your conviction records sealed, dismissed, or expunged?*
Have you ever had your vehicle searched by law enforcement or any governmental agency?*
Have you ever violated a restraining order?*
Have you ever fraudulently altered any type of document?*
Have you ever been accused of any crime?*
Have you ever had a warrant issued for your arrest?*
Have you ever been detained or questioned (stopped/held) by police?*
Have you ever given false information to a police officer, security officer, or loss prevention officer?*
Have you ever been arrested?*

LEGAL (continued)

Have you ever been handcuffed by police?*
Have the police ever been called regarding an incident you were involved in?*
Have you ever been to court for anything other than a traffic citation?*
Are you currently under investigation by any law enforcement agency for any reason?*
Have you ever violated a condition of probation?*
Have you ever been on probation?*
Have you ever participated in a riot, protest, or demonstration?*
Have you ever broken into a house, school, business, or other building?*
Have you ever harmed or caused injury to anyone?*
Have you ever accepted a bribe of any type?*
Have you ever taken or kept money or other valuable entrusted to you?*
Have you ever committed any type of fraud?*
Have you ever threatened anyone with physical violence?*
Have you ever trespassed on any property?*
Have you ever vandalized, damaged, or destroyed property?*
Have you ever committed robbery?*
Have you ever committed burglary?*
Have you ever kidnapped anyone?*
Have you ever killed or attempted to kill anyone?*
Have you ever stolen anything after the age of 14?*
Have you ever illegally shared or spliced into someone else’s cable, internet service, or other utilities?*
Have you ever eaten at a restaurant and left without paying?*
Have you ever used someone else’s social security number?*
Have you ever taken or used someone else’s credit card or credit card number without their permission?*
Have you ever purchased, manufactured, or otherwise obtained or used a fictitious/forged identification or used another person’s identification for any purpose?*
Have you ever kept found property that did not belong to you?*
Have you ever been with someone when they committed a crime?*

LEGAL – PERSONAL BEHAVIOR

Sexual activity includes any and all sex acts, including intercourse, oral copulation, phone sex, cybersex, masturbation, fondling or any related type of sex act.
Have you ever used or solicited the services of a prostitute inside or outside the United States?*
Have you ever committed prostitution (received money, drugs, or property for any sexual act)?*
Have you ever used a prostitute who was under the age of 18 or who you suspected of being under the age of 18?*
Have you ever been to a strip club (if “yes”, how many times and when was the last time)?*
Have you ever been to a function where a stripper performed?*
Have you ever solicited any lewd act in a public place?*
Have you ever derived any financial support by soliciting prostitution for prostitutes (pimping)?*
Have you ever encouraged or recruited persons to be a prostitute (pandering)?*
Have you ever used any type of drug or narcotic or any type of intoxicating chemical to seduce or overpower someone to have sex with you knowing it was without their permission?*
Have you ever coerced or tricked someone to have sex with you or someone else without his or her consent?*
Since the age of 18, have you ever had sex with someone under the age of 18 or who you suspected, or claimed to be under the age of 18?*
Have you ever had a dating or sexual relationship with anyone related to you?*
Have you ever forced a person to have sex with you and/or someone else?*
Have you ever had sex with a relative or member of your family other than your spouse?*
Have you ever viewed, purchased, sold, participated or subscribed to child pornography or animated child porn?*
Have you ever had sexual contact with a child (fondling, taking pornographic pictures, masturbating in a child’s presence, oral sex, sexual intercourse, etc.)?*
Have you ever illegally exposed yourself (genitals) to anyone?*
Have you ever had sex or masturbated in a public place or in public view? i.e. movie theater, restroom, park, dressing room, or any other place open to the public including parked cars?*