For any attach a separate sheet with a written explanation ‘Yes’ answers below, Section D: Have you ever worked for a law enforcement agency? Yes No Where? Dates: Did you have any complaints made against you by any member of the public? Yes No Did you have any complaints made against you by any law enforcement personnel, Yes No including supervisors or administrators? Did you have a claim or lawsuit filed against you or your employing agency based Yes No on allegations of negligent or wrongful acts or omission by you? Did you have any disciplinary action taken against you by a law enforcement Yes No employer? Have you ever been requested or ordered to take a polygraph exam or any other Yes No form of truth/deception technology? Please list any previous law enforcement training: Legal History: For any attach a separate sheet with a written explanation. ‘Yes’ answers below, Section E: Do you know of any reason that you could not pass a background check? Yes No Have you ever stolen from an employer? Yes No Have you ever assisted someone in committing a crime? Yes No Have you ever accepted money to not to report a crime? Yes No Have you ever used, sold, or otherwise handled in an illegal manner any controlled Yes No substance? Have you ever committed a crime for which you were not arrested? Yes No Have you ever taken a prescription that was not legally prescribed to you by a Yes No medical doctor? Have you ever been convicted of a misdemeanor crime (Does not include traffic Yes No citations or other infractions)? Has any to you in any State ever been suspended or Yes No driver’s license issued revoked? Have you ever been placed on informal or formal probation or parole by a court of Yes No law? Have you ever been convicted of a Felony? Yes No Have you ever had automobile insurance refused, withdrawn, revoked or been Yes No required to obtain special risk insurances? Military History:
For any ‘Yes’ answers below, attach a separate sheet with a written explanation Section D: Have you ever worked for a law enforcement agency? Where? Dates: Yes No Did you have any complaints made against you by any member of the public? Yes No Did you have any complaints made against you by any law enforcement personnel, including supervisors or administrators? Yes No Did you have a claim or lawsuit filed against you or your employing agency based on allegations of negligent or wrongful acts or omission by you? Yes No Did you have any disciplinary action taken against you by a law enforcement employer? Yes No Have you ever been requested or ordered to take a polygraph exam or any other form of truth/deception technology? Yes No Please list any previous law enforcement training: Legal History: For any ‘Yes’ answers below, attach a separate sheet with a written explanation. Section E: Do you know of any reason that you could not pass a background check? Yes No Have you ever stolen from an employer? Yes No Have you ever assisted someone in committing a crime? Yes No Have you ever accepted money to not to report a crime? Yes No Have you ever used, sold, or otherwise handled in an illegal manner any controlled substance? Yes No Have you ever committed a crime for which you were not arrested? Yes No Have you ever taken a prescription that was not legally prescribed to you by a medical doctor? Yes No Have you ever been convicted of a misdemeanor crime (Does not include traffic citations or other infractions)? Yes No Has any driver’s license issued to you in any State ever been suspended or revoked? Yes No Have you ever been placed on informal or formal probation or parole by a court of law? Yes No Have you ever been convicted of a Felony? Yes No Have you ever had automobile insurance refused, withdrawn, revoked or been required to obtain special risk insurances? Yes No Military History:
probationapplication2017withoutautofill.docx