Official SealDepartment of Budget and Management


#19-002106-0001
Supplemental Questionnaire

Last Name
First Name

 
Answer all questions truthfully.  Applicants are reminded that all information will be investigated and verified through a background investigation and polygraph examination.  Any willful misrepresentations, omissions, or falsifications during any phase of the employment process shall disqualify you from further consideration for employment.

1.

Will you be at least 18 years of age by October 1, 2019?

Yes No
2.

Will you be 21 years of age or older on October 1, 2019?

Yes No
3.

Are you currently a citizen of the United States?

Yes No
4.

Have you ever formally renounced your United States citizenship?

Yes No
5.

Will you have successfully completed a high school education or equivalent?

Yes, I will possess a high school diploma by June 30, 2019.
Yes, I will possess a GED by June 30, 2019.
No, I will not possess a high school diploma or GED.
6.

Do you currently, or will you possess a valid driver's license by September 1, 2019?

Yes No
7.
Have you ever been discharged from the United States Armed Forces under dishonorable conditions?
Yes No
8.
Have you ever been convicted in any court of a crime punishable by imprisonment for a term exceeding one year?
Yes No
9.
Have you ever been convicted of a felony?
Yes No
10.
Have you ever been convicted of a crime of domestic violence?
Yes No
11.
Are you currently the subject of a court order that restrains you from harassing, stalking, or threatening an intimate partner or child of such intimate partner?
Yes No
12.
Have you ever been convicted or otherwise found guilty of selling, manufacturing, or distributing a controlled dangerous substance, narcotic drug, or marijuana?
Yes No
13.
Have you ever illegally sold, produced, cultivated, distributed, or transported a controlled dangerous substance, narcotic drug, or marijuana?
Yes No
14.
Have you ever illegally used a controlled dangerous substance, narcotic drug, or marijuana while employed to enforce federal, State, or local law by any government entity?
Yes No
15.
Have you ever used Heroin, Phencyclodine (PCP), or Lysergic acid diethylamide (LSD)?
Yes No
16.

Other than heroin, PCP, LSD, or marijuana, have you ever illegally used any controlled dangerous substance or narcotic drug, or any combination of controlled dangerous substances or narcotic drugs in excess of a total of five times?

Yes No
17.

Have you used a controlled dangerous substance, narcotic drug, or marijuana for any purpose within 36 months of your 21st birthday?

Yes No

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