Official SealHuman Resource Services Department

Supplemental Questionnaire

Last Name
First Name


Thank you for your interest in the position of Sheriff's Safety Aide, Examination #23-8752-01. Applicants for this position are required to submit responses to the following supplemental questions. Your completed responses to the supplemental questionnaire will be evaluated to further verify minimum qualifications. Failure to answer these questions truthfully may result in disqualification from the examination process.


Do you possess a high school diploma, G.E.D. equivalency or high school proficiency certificate?

Yes No

Do you possess a valid California's driver's license?

Yes No


The following questions, #3 through #5, are required in accordance with the Federal Prison Rape Elimination Act (PREA) of 2003, Standard 115.17/115.117/115.217/115.317.  Have you ever?


Engaged in sexual abuse in a prison, jail, lockup, community confinement facility, juvenile facility, or other institution (as defined by 42 U.S.C. 1997)?

Yes No

Been convicted of engaging or attempting to engage in sexual activity in the community facilitated by force, overt or implied threats of force, or coercion, or if the victim did not consent or was unable to consent or refuse?

Yes No

Been civilly or administratively adjudicated to have engaged in the activity described in question #4?

Yes No

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