Pre Background Questionnaire Form PDF Details

When applying for a position within the San Bernardino County Sheriff's Department, a critical and comprehensive step is completing the Pre-Background Interview Questionnaire. This form is meticulously designed to gather a wide range of personal, financial, and professional information from applicants, extending even to details about one's military service and driving history. The questionnaire serves as a supplement to the Personal History Statement or application, aiming to ensure candidates meet the high standards required for roles that demand integrity, honesty, and trustworthiness. It is crucial for applicants to approach this form with utmost sincerity, as inaccuracies or omissions can lead to disqualification. The questionnaire explicitly instructs not to disclose medical or disability-related information, in compliance with the Americans with Disabilities Act (ADA), highlighting the Department's commitment to privacy and equal opportunity. Additionally, candidates are reminded of the possibility of verification through a polygraph examination, emphasizing the importance of truthfulness. This thorough vetting process underscores the Department's dedication to understanding the character and history of its prospective employees, ensuring that they possess the moral and ethical standards consistent with the responsibilities of law enforcement positions.

QuestionAnswer
Form NamePre Background Questionnaire Form
Form Length17 pages
Fillable?No
Fillable fields0
Avg. time to fill out4 min 15 sec
Other namespre background interview questionnaire, BEASTIALITY, san pre questionnaire, telework questionnaire

Form Preview Example

SAN BERNARDINO COUNTY SHERIFF’S DEPARTMENT PRE-BACKGROUND INTERVIEW QUESTIONNAIRE

Date: ______________________ Position Applied for: __________________________________

Name: _______________________________ Social Security Number:_____________________

LastFirst

Date of Birth:________________ Driver’s License Number: _________________ State:______

Address: _____________________ City: _________________ State: ______ Zip Code: _______

Telephone: ____________________

_____________________

_____________________

Home

Cell

Work

E-Mail Address(s): _______________________________________________________________

How did you hear about the San Bernardino County Sheriff’s Department?

(Check One)

County Human Resources

Department Member

Advertisement

Job Fair

Sheriff’s Website

Other:

As an applicant for a position with the San Bernardino County Sheriff’s Department, you are required to complete this background questionnaire. This questionnaire supplements your Personal History Statement (PHS) or application, which will be treated in the same manner.

Pursuant to the Americans with Disabilities Act (ADA), you are not required nor are you expected to furnish any information in this questionnaire that is of a medical nature. For example, do not report any work absences for illness or workers compensation claims. Do not discuss or report any disabilities you might have. This information is strictly medical in nature, and as this questionnaire is part of the pre-job offer background investigation, is not subject to disclosure during this portion of the background investigation.

For the purpose of this questionnaire, drug possession shall be defined as each time the drug was in your personal possession either on or within the body or in the hands, clothing, vehicle, home, residence or any other area that you controlled.

Please read and answer all of the questions. You are admonished to answer all questions completely and truthfully. If you are dishonest in your answers, fail to fully answer any question, or misstate any material facts, you will be disqualified from further consideration for this position. Remember that your response may be subject to verification by a polygraph examination.

PRE-BACKGROUND INTERVIEW QUESTIONNAIRE.doc

BACKGROUND INTERVIEW QUESTIONNAIRE

INSTRUCTION SHEET

Carefully read and answer each question.

If you answer “YES” to any question, you must write a complete explanation in handwriting on the blank sheets attached (use additional paper if needed).

Print only using black ink.

All written responses must be answered completely, accurately and truthfully. (Provide dates, locations, amounts, etc.)

Write the corresponding question number adjacent to the written explanation.

After completing each page, you must initial the bottom right corner of each page.

In accordance with the Americans with Disabilities Act (ADA), do not list any medical related information or history about yourself on this questionnaire or any attached pages.

Vague, ambiguous, misleading, illegible or unanswered responses may be cause for disqualification from further consideration.

If you see the word “ever” in any question that means your entire lifetime.

San Bernardino County Sheriff’s Department employees must be able to read, interpret, comprehend, and complete police reports, forms and other documents accurately and in a timely manner. For this reason, in addition to evaluating your moral character and suitability, we will evaluate your ability to complete this questionnaire accurately. Your ability to write clear statements, which accurately describe an occurrence, will be evaluated.

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ADVISEMENT TO APPLICANT

The purpose of a pre-employment background investigation, for all intents and purposes, is to verify that the application you have submitted and any statements you have made to the San Bernardino County Sheriff’s Department, concerning your qualifications, are true.

The California Courts have held that an employer has a legal duty to know the persons whom it employs. In some cases, California law may mandate a background investigation before employment, while in other cases it is merely a case of public policy or prudence before placing someone in a position of public trust.

Both State and Federal Courts have also held that there is an absolute necessity for public employees to be truthful. You must understand that a lack of truthfulness or deception of any type on your part will automatically and irrevocably result in your application being rejected from further consideration.

For some people, there may be one or more incidents or occurrences in their background which they regret or over which they may feel some embarrassment. A prospective employer will not make inquiries into areas of a person’s background which have no legitimate bearing on their qualifications for the job. However, you should understand that the mere presence of so-called “negative” information in your background is not automatically disqualifying. For example, an applicant may have engaged in petty thievery as a child, have used illegal drugs, may have been fired from a job or even have been convicted of a crime as an adult. While these things, in and of themselves, may not automatically remove that person from consideration for a job, lying about them will.

A pre-employment background investigation is not intended to be an intimidating experience or an unwarranted invasion into your privacy. Your background investigator will contact persons who know you, including present and/or former employers, and will examine official documents and records concerning you to assure that you have been honest in your application in order to fulfill the legal mandates imposed by the Courts and the Legislature. The more forthright you have been, the greater the likelihood that your background can be completed in a timely and successful manner.

CERTIFICATION

I understand that any false statements and/or deliberate misrepresentations, whether by omission or commission, will result in my application being automatically and irrevocably rejected from further consideration. I certify that I have read the above statement, understand its contents and have been furnished a copy of it.

Dated this______day of________________, 20___, in the County of San Bernardino, State of California.

___________________________________

___________________________________

Signature of Applicant

Signature of SBSD Agent

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PERSONAL DATA

1.

Do you use, or are you known by any other names, or monikers, or aliases?

Yes

No

 

 

 

2.

Have you ever impersonated another person?

Yes

No

 

 

 

3.

Have you ever impersonated a police officer?

Yes

No

 

 

 

FINANCIAL STATUS

4.

Have you ever provided false information on a credit or loan application?

Yes

No

 

 

 

 

5.

Have you ever had a poor credit rating?

Yes

No

 

 

 

 

6.

Have you ever been refused credit?

Yes

No

 

 

 

 

7.

Have you ever been evicted or threatened with an eviction process?

Yes

No

 

 

 

 

8.

Have you ever been sued over a debt?

Yes

No

 

 

 

 

9.

Have you ever filed for debt reorganization?

Yes

No

 

 

 

 

10.

Have you ever written a check knowing funds were not available to cover payment?

Yes

No

 

 

 

 

11.

Have you ever bounced a check? If so, what did you do about it?

Yes

No

 

 

 

 

12.

Have you ever had a debt turned over to a collection agency?

Yes

No

 

 

 

 

13.

Have you ever been late paying rent or a mortgage payment?

Yes

No

 

 

 

 

14.

Has your salary ever been attached for non-payment of debts?

Yes

No

 

 

 

 

15.

Have you ever avoided paying any lawful debt by moving away?

Yes

No

 

 

 

 

16.

Have you ever been late paying your taxes?

Yes

No

 

 

 

 

17.

Have you ever failed to support any child of yours?

Yes

No

 

 

 

 

18.

Have you ever been late in repaying a student loan?

Yes

No

 

 

 

 

19.

Have you ever filed a false insurance claim?

Yes

No

 

 

 

 

20.

Have you ever-obtained financial gain through dishonest means?

Yes

No

 

 

 

 

21.

Have you ever collected unemployment or welfare benefits (including food stamps)

Yes

No

when you were not entitled?

 

 

 

22.

During your background investigation, is anyone likely to report that you have or

Yes

No

had financial problems?

 

 

 

23.

Have you ever filed Bankruptcy or Chapter 13 relief?

Yes

No

 

 

 

 

24.

Have you ever falsified any information on a Bankruptcy Petition?

Yes

No

 

 

 

 

25.

Have you ever had any property, including a vehicle, repossessed?

Yes

No

 

 

 

 

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MILITARY (IF APPLICABLE)

26.

Did you ever fail to register for the military draft when required to do so by law?

Yes

No

 

 

 

 

27.

Are you concerned about an investigation into your military record?

Yes

No

 

 

 

 

28.

Have you ever been denied enlistment or re-enlistment in the military service?

Yes

No

 

 

 

 

29.

Were you discharged from the military in any way other than honorable?

Yes

No

 

 

 

 

30.

Have you ever been considered absent without leave (A.W.O.L.) or taken an

Yes

No

unauthorized absence from the military?

 

 

 

31.

Were you ever restricted to the base?

Yes

No

 

 

 

 

32.

Were you ever in military confinement?

Yes

No

 

 

 

 

33.

Were you ever court-martialed or subject to an administrative discharge board?

Yes

No

 

 

 

 

34.

Did you ever receive non-judicial punishment, non-judicial office hours, Captain’s

Yes

No

Mast, or similar punishment?

 

 

 

35.

While in military, did you receive any type of disciplinary action?

Yes

No

 

 

 

 

36.

While in the military, were you ever reduced in grade or rank?

Yes

No

 

 

 

 

37.

During your background investigation, is anyone likely to report that you had any

Yes

No

other problems while in the military?

 

 

 

38.

Did you ever use deadly force while in the military?

Yes

No

 

 

 

 

TRAFFIC/VEHICLE OPERATION

39.

Has your driver’s license ever been suspended or revoked?

Yes

No

 

 

 

 

40.

Have you ever received a traffic citation, other than for parking?

Yes

No

 

 

 

 

41.

Have you ever had a traffic citation that did not show on your DMV record?

Yes

No

 

 

 

 

42.

Have you ever had a traffic citation go to warrant? If yes, include dates and county

Yes

No

where original violation took place.

 

 

 

43.

Are you currently driving without automobile insurance? If yes, for how long?

Yes

No

 

 

 

 

44.

Have you ever driven an uninsured vehicle? If yes, please give specific time frames.

Yes

No

 

 

 

 

45.

Have you ever been denied vehicle insurance?

Yes

No

 

 

 

 

46.

Have you ever been placed on probation for a traffic-related offense?

Yes

No

 

 

 

 

47.

Have you ever been involved in a police pursuit?

Yes

No

 

 

 

 

48.

Have you ever fled the scene of a traffic accident?

Yes

No

 

 

 

 

49.

Have you ever caused anyone serious injury or death by your operation of a motor

Yes

No

vehicle?

 

 

 

50.

Have you ever driven a vehicle without a valid drivers license?

Yes

No

 

 

 

 

51.

As a driver, have you ever been involved in a traffic collision? If yes, explain (give

Yes

No

dates, locations, whether you were at fault)

 

 

 

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PERSONAL CONDUCT

52.

Have you ever been arrested for an illegal sex act?

Yes

No

 

 

 

 

53.

Have you received payment for or have you paid for sexual acts?

Yes

No

 

 

 

 

54.

Have you ever illegally exposed your genitals?

Yes

No

 

 

 

 

55.

Have you ever had to register as a sex offender?

Yes

No

 

 

 

 

56.

Have you any reason to be concerned about an investigation into your personality

Yes

No

traits?

 

 

 

57.

Do you have any prejudices against any minority, religious, or militant groups?

Yes

No

 

 

 

 

58.

During your background investigation, is anyone likely to report that you have any

Yes

No

prejudices against any minority, religious, or militant groups?

 

 

 

59.

Do you feel your prejudices might affect your ability to perform this job?

Yes

No

 

 

 

 

USE OF INTOXICANTS

60.

Have you ever been detained or arrested for driving under the influence of an

Yes

No

intoxicant?

 

 

 

61.

Have you ever driven a vehicle under the influence of alcohol and/or drugs? If so,

Yes

No

give the date of the last occurrence.

 

 

 

GAMBLING

62.

Have you had any family problems because of gambling?

Yes

No

 

 

 

 

63.

Have you had any employment problems because of gambling?

Yes

No

 

 

 

 

64.

Have you ever placed an illegal bet on a sporting event?

Yes

No

 

 

 

 

65.

Have you ever gambled while delinquent or behind in your financial obligations?

Yes

No

 

 

 

 

 

66.

Have you gambled in the last year?

 

Yes

No

 

 

 

 

67.

Have you ever borrowed money to gamble with?

Yes

No

 

 

 

 

68.

What is the most you have ever lost by gambling and won by gambling?

Yes

No

Total Losses:

Total Winnings:

 

 

 

EMPLOYMENT HISTORY

69.

Have you ever called in sick when you were really well? If yes, why?

Yes

No

 

 

 

 

70.

Have you ever had any difficulty with a co-worker, subordinate, or supervisor?

Yes

No

 

 

 

 

71.

During the course of your employment, have you ever had a complaint made against

Yes

No

you?

 

 

 

72.

Has any teacher or supervisor (including military) ever spoken to you about being

Yes

No

tardy or absent too often?

 

 

 

73.

Have you ever been in a fight (verbal or physical) with a co-worker, supervisor,

Yes

No

teacher, or customer of an organization you were working?

 

 

 

74.

Have you ever been accused of misconduct at a place of employment?

Yes

No

 

 

 

 

75.

Are you concerned about an investigation into your past work history?

Yes

No

 

 

 

 

76.

Were you ever fired from a job? If yes, please include employers and dates.

Yes

No

 

 

 

 

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77.

Were you ever asked to resign from a job? If yes, include employers and dates.

Yes

No

 

 

 

 

78.

Did you ever resign from a job to avoid being fired?

Yes

No

 

 

 

 

79.

Have you ever left a job without giving proper notice?

Yes

No

 

 

 

 

80.

Have you been disciplined by an employer?

Yes

No

 

 

 

 

81.

Are there any reasons for you not showing true and complete explanation(s) for

Yes

No

leaving each of your previous jobs?

 

 

 

82.

Have you ever left a job with hard feelings toward the management or co-workers?

Yes

No

 

 

 

 

83.

Are there any reasons you could not return to work for all of your former

Yes

No

employers?

 

 

 

84.

Have you ever stolen any money from a place where you worked?

Yes

No

 

 

 

 

85

During your background investigation, is anyone likely to report derogatory

Yes

No

information about your work performance?

 

 

 

86.

Have you ever borrowed money from an employer with or without their permission

Yes

No

and not paid it back?

 

 

 

87.

Have you ever been over paid by an employer and not reported it?

Yes

No

 

 

 

 

88.

Have you ever embezzled any money from an employer?

Yes

No

 

 

 

 

89.

Have you ever stolen, given away or discounted any merchandise or property from

Yes

No

any employer?

 

 

 

90.

Have you ever stolen any merchandise or property from an employer?

Yes

No

 

 

 

 

91.

Have you ever taken any property that didn’t belong to you from a place where you

Yes

No

worked? If yes, include name of employer.

 

 

 

92.

During your background investigation, is anyone likely to report that you have

Yes

No

stolen something from a place where you worked?

 

 

 

93.

Have you ever been accused of sexual harassment? If yes, was there an

Yes

No

investigation conducted?

 

 

 

94.

Has a bonding company ever turned you down?

Yes

No

 

 

 

 

95.

Have you ever filed a false worker’s compensation claim?

Yes

No

 

 

 

 

GOVERNMENT APPLICATIONS

96.

Have you ever previously applied to the San Bernardino County Sheriff’s

Yes

No

Department for a sworn and/or civilian position?

 

 

 

97.

Have you ever applied to another law enforcement agency?

Yes

No

 

 

 

 

98.

Have you ever been rejected by this or any other law enforcement agency for any

Yes

No

reason?

 

 

 

99.

Have you ever worked at this or any other law enforcement agency in any capacity?

Yes

No

 

 

 

 

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CRIMINAL BEHAVIOR/LAW ENFORCEMENT CONTACTS

100.Have you ever committed any of the following?

A. ARSON (unlawfully set fire)

Yes

No

 

 

 

B. BURGLARY (entry of a structure or vehicle to commit theft or any felony)

Yes

No

 

 

 

C. ROBBERY (theft from another person using a weapon or force)

Yes

No

 

 

 

 

D.

HOMICIDE / MANSLAUGHTER

Yes

No

 

 

 

E. THEFT (including switching price tags, shoplifting)

Yes

No

 

 

 

 

F.

FORGERY

Yes

No

 

 

 

 

G.

KIDNAPPING

Yes

No

 

 

 

 

H.

EXTORTION (blackmail)

Yes

No

 

 

 

I. EMBEZZLEMENT (theft of money or other valuables entrusted to you)

Yes

No

 

 

 

J. RAPE (sexual intercourse by force, threat, alcohol or drug, including your spouse)

Yes

No

 

 

 

K. ANY SEX ACT WITH A PERSON UNDER AGE 18

Yes

No

 

 

 

 

L.

INCEST (sexual intercourse with a member of your immediate family, other than

Yes

No

your spouse)

M. SEX IN A PLACE EXPOSED TO PUBLIC VIEW

Yes

No

 

 

 

 

N.

VIOLENT ASSAULT UPON ANOTHER PERSON (including spouse, significant

Yes

No

others)

O. DOMESTIC VIOLENCE (including spouse, common-law, significant others):

 

 

 

1. Have you ever assaulted another person in a dating relationship or during the

Yes

No

 

relationship’s termination?

 

 

 

2. Have you ever committed any act of physical violence (i.e. slapping, hitting,

 

 

 

beating, arm-twisting, spitting, etc.) within an intimate relationship

Yes

No

 

(including casual and long-term relationships)?

 

 

P.

CHILD/ELDER ABUSE:

 

 

1. Have you ever neglected the care of a child or elderly person who was your

 

 

 

Yes

No

 

responsibility (i.e. did not feed, clean, clothe, or take care of medical needs

 

 

 

 

as deemed appropriate, etc.)?

 

 

Q.

CHILD MOLESTATION (any sex act with a child)

 

 

1. Have you ever had sexual contact with a child (i.e. fondling, taking

 

 

 

Yes

No

 

pornographic pictures, masturbating in a child’s presence, sexual acts, sexual

 

 

 

 

intercourse)?

 

 

R. BEASTIALITY (any sex act with an animal)

Yes

No

 

 

 

 

S.

PROSTITUTION OR OTHER ILLEGAL SEXUAL ACTS (intercourse or other

Yes

No

sexual acts for money or other considerations)

 

 

 

T.

SOLICITING PROSTITUTION (asking for sex in exchange for money or other

Yes

No

considerations)

 

 

 

U.

VANDALISM (illegally damaged or destroyed property or committed any act of

Yes

No

malicious mischief)

 

 

 

V.

PUBLIC INTOXICATION

Yes

No

 

 

 

 

W.

COMPUTER CRIMES (fraud, identity theft, or false impersonations, cyber sex,

Yes

No

child pornography, solicited sexual acts from a person under 18 years old).

 

 

 

101. Have you ever carried a concealed weapon without a permit to do so?

Yes

No

 

 

 

 

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102

Are you prohibited by law from owning, possessing, or carrying a firearm?

Yes

No

 

 

 

 

103.

Have you ever applied for a permit to carry a concealed weapon?

Yes

No

 

 

 

 

 

Have you ever illegally carried a weapon? (Includes any dagger, billy club, metal

 

 

104.

knuckles, nunchaku, throwing star, sap, short-barreled shotgun/rifle, butterfly knife,

Yes

No

 

or any explosive substance.)

 

 

105.

During your background investigation, is anyone likely to report that you have

Yes

No

 

illegally used or carried a firearm?

 

 

 

Either as an adult or juvenile, have you ever been questioned or detained by any law

 

 

106.

enforcement agency during an investigation? (Detention in and of itself is not

Yes

No

 

disqualifying.)

 

 

107.

Have you ever been placed on court probation as a juvenile or an adult? If yes, give

Yes

No

 

details (including dates, where and why.)

 

 

108.

Have you ever had a warrant issued for your arrest (including traffic warrants)? If

Yes

No

 

yes, give details (including dates, where and why.)

 

 

109.

Are you currently, or have you ever been on parole or probation? If yes, give details

Yes

No

 

(including dates, where and why.)

 

 

 

Have you ever been arrested or convicted of any crime, as an adult or juvenile

 

 

110.

(excluding traffic citations)? If so, please provide the following information: Date

Yes

No

of incident, police agency, circumstances, sentences, court case number, police case

 

number, police reports, and court).

 

 

111.

Are you now wanted for any reason by any law enforcement agency?

Yes

No

 

 

 

 

112.

Have you ever had a criminal record (adult or juvenile) sealed?

Yes

No

 

 

 

 

113.

Have you ever had to testify in a criminal proceeding?

Yes

No

 

 

 

 

114.

Have you ever had your vehicle searched?

Yes

No

 

 

 

 

115.

Have you ever been reported to any law enforcement agency as a runaway or

Yes

No

missing person?

116.

Have you ever been named on or been party to a restraining order?

Yes

No

 

 

 

 

117.

Have you ever refused to obey a restraining order?

Yes

No

 

 

 

 

118.

Has your spouse ever called the police on you for any reason?

Yes

No

 

 

 

 

119.

Have you ever been a victim of gang violence?

Yes

No

 

 

 

 

120.

Have you ever “tagged” or participated in “tagging” someone else’s property?

Yes

No

 

 

 

 

121.

Have you ever had a drunk driving arrest reduced to a reckless driving?

Yes

No

 

 

 

 

122.

Have you ever engaged in any criminal activity using a computer or any other

Yes

No

 

communication device?

 

 

123.

Have you ever been a victim of a criminal act?

Yes

No

 

 

 

 

 

Have you ever committed any dishonest act in order to obtain a Police Officer

 

 

124.

position? (i.e., cheating on written exam, or having another person take your medical

Yes

No

 

exam, etc.?)

 

 

125.

Have you ever used falsified identification or identification belonging to another?

Yes

No

 

 

 

 

126.

Have you cheated on a test?

Yes

No

 

 

 

 

127.

Did you omit from your application any employment issues (i.e., terminations, or

Yes

No

 

layoffs)?

 

 

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HONESTY

128.

Have you intentionally omitted any fact or facts from your application or withheld

Yes

No

 

any adverse information from the background investigator?

 

129.

Have you ever given any confidential information to any organization or individual

Yes

No

 

 

that would jeopardize our national security?

 

 

 

 

FRIENDS, ASSOCIATES & FAMILY MEMBERS

 

 

 

 

 

 

 

 

130.

Have you ever had any difficulties or disputes with a neighbor?

Yes

No

 

 

 

 

 

 

131.

Has any of your high school, college friends or current associates ever been

Yes

No

 

convicted of a crime?

 

132.

Have you ever committed a crime not previously mentioned?

Yes

No

 

 

 

 

 

 

133.

Have you or your family or associates ever violated any law while associating with

Yes

No

 

members of a street gang?

 

134.

Have you, your family or associates ever participated in a drive by shooting of a

Yes

No

 

person, home or vehicle? If yes, what role did you play?

 

135.

Do you know, or have you or your family members ever knowingly associated with

Yes

No

 

 

any member of a street gang?

 

 

 

136.

Have you ever been a member or participated in any gang activity?

Yes

No

 

 

 

 

 

 

137.

Have you ever attended a gathering of any street gang?

Yes

No

 

 

 

 

 

 

138.

To your knowledge, have any of your immediate family members, friends, or

Yes

No

 

 

associates ever been arrested or are they now involved in any illegal activity?

 

 

 

139.

Have any of your family members or associates ever been placed on probation or

Yes

No

 

 

parole?

 

 

 

 

During your background investigation, is anyone likely to report that you have any

 

 

 

140

personality characteristics that would make you unsuitable for the position you have

Yes

No

 

 

applied for?

 

 

 

141.

Do you now or have you ever had any character defects?

Yes

No

 

 

 

 

 

 

 

DRUGS AND NARCOTICS

 

 

 

 

 

 

 

 

142.

Do any of your friends, immediate family, or associates use any drugs, narcotics, or

Yes

No

 

other illegal substances? If yes, are you in contact with them?

 

143.

Have you ever remained in a place where drugs, narcotics or other illegal substances

Yes

No

 

were being used, possessed, sold, manufactured, etc.?

 

144.

Have you ever purchased narcotics or drugs, including marijuana, without a doctor’s

Yes

No

 

prescription?

 

145.

Have you ever furnished, manufactured, cultivated or possessed any drug, narcotic,

Yes

No

 

or other illegal substance?

 

146.

Have you ever knowingly allowed anyone to use illegal drugs in your home?

Yes

No

 

 

 

 

 

 

147.

Have you ever sold narcotics or drugs, including marijuana?

Yes

No

 

 

 

 

 

 

148.

Have you ever worked under the influence of illegal drugs?

Yes

No

 

 

 

 

 

 

149.

Have you ever ingested a substance you thought was an illegal drug and then found

Yes

No

 

 

out it wasn’t?

 

 

 

150.

Have you ever been involved in the manufacturing of any drugs?

Yes

No

 

 

 

 

 

 

151.

Have you ever been the “middle man” for a drug deal?

Yes

No

 

 

 

 

 

 

152.

Have you ever purchased steroids?

Yes

No

 

 

 

 

 

 

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153.

Have you ever helped another person purchase steroids?

 

 

Yes

No

 

 

 

 

 

 

154.

Have you or anyone else (other than medical personnel) injected anything into your

Yes

No

body?

 

 

 

155.

If applying for Deputy Sheriff: Would you arrest a friend if you came upon that

Yes

No

friend using narcotics or illegal drugs?

 

 

 

156.

Do you object to other people using illegal drugs or narcotics?

Yes

No

 

 

 

 

 

 

157.

During your background investigation, is anyone likely to report that you have been

Yes

No

involved in the use or sales of illegal drugs?

 

 

 

158.

Have you ever-tested positive on an employment related drug test?

Yes

No

 

 

 

 

 

 

 

 

 

 

 

 

159.

Have you EVER, during the course of your lifetime, used, tried,

 

Month/Year

Month/Year

experimented, or in ANY WAY ingested into your body:

 

First Used

Last Used

Marijuana (THC/STP)

Yes

No

 

 

 

 

 

 

 

 

 

Hashish / Hash Oil

Yes

No

 

 

 

 

 

 

 

 

 

Cocaine

Yes

No

 

 

 

 

 

 

 

 

 

Barbiturates (Downers)

Yes

No

 

 

 

 

 

 

 

 

 

Amphetamines (Uppers, Speed)

Yes

No

 

 

 

 

 

 

 

 

 

 

Heroin

 

Yes

No

 

 

 

 

 

 

 

 

 

LSD (Acid), Mushrooms, or other Hallucinogens

Yes

No

 

 

 

 

 

 

 

 

 

Peyote or Mescaline

Yes

No

 

 

 

 

 

 

 

 

 

Opium / Morphine

Yes

No

 

 

 

 

 

 

 

 

 

PCP (Angel Dust)

Yes

No

 

 

 

 

 

 

 

 

 

Steroids – Oral or Injectable (Other than prescribed)

Yes

No

 

 

 

 

 

 

 

 

 

Toluene (Inhalants)

Yes

No

 

 

 

 

 

 

 

 

 

Combination of Substances or any “Designer Drug”

Yes

No

 

 

 

 

 

 

 

 

 

Ecstasy, GHB

Yes

No

 

 

 

 

 

 

 

 

 

Any other drug (Other than prescribed)

Yes

No

 

 

 

 

 

 

 

 

 

 

If you have used any of the listed drugs above or any other illegal drug, you must write a complete explanation in handwriting on the blank sheets attached. Be specific as possible.

TEMPERAMENT

160. Do you frequently lose your temper?

Yes

No

 

 

 

 

161.

Have you ever lost your temper with your family, friends, co-workers, supervisors, or

Yes

No

a stranger?

162.

Have you ever been involved in a fight? If yes, give details.

Yes

No

 

 

 

 

163.

In the past year, have you ever been in or started any fights?

Yes

No

 

 

 

 

164.

Since you were 18, have you struck or injured any person?

Yes

No

 

 

 

 

165.

Have you ever struck someone living with you?

Yes

No

 

 

 

 

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166.

Have you had to physically defend yourself? If yes, how many times (other than

Yes

No

training, e.g., military, police academy, or self-defense courses, etc.)?

167.

Other than in warfare, have you ever caused serious injury to a human being?

Yes

No

 

 

 

 

168.

Other than in warfare, have you ever used any weapon against someone?

Yes

No

 

 

 

 

 

Other than in warfare, have you been involved in a violent incident such as a

 

 

169.

shooting, knifing, or fight where someone was, or could have been, seriously injured

Yes

No

 

or killed?

 

 

170.

Other than in warfare, have you ever caused the death of a human being?

Yes

No

 

 

 

 

 

If applying for Deputy Sheriff: If it becomes necessary in the course of your duties to

 

 

171.

take a human life, would you have any reluctance to do so because of religious or

Yes

No

 

other personal beliefs?

 

 

172.

During your background investigation, is anyone likely to report that you have violent

Yes

No

 

tendencies?

 

 

173.

During your background investigation, is anyone likely to report that you have a

Yes

No

 

problem with your temper?

 

 

 

Have you ever mentally or emotionally abused someone in an intimate relationship

 

 

174.

(i.e. frequently called them harmful names, threatened them, terrorized them,

Yes

No

humiliated them, insulted them, intentionally tried to hurt their feelings, or make them

 

feel bad?)

 

 

175.

Have you ever been in a physical confrontation with someone in an intimate

Yes

No

relationship (i.e. push, shove, hit, slap, hold, grab, etc.)?

 

Have you ever been controlling in an intimate relationship (i.e. told partners what to

 

 

176.

wear, whom they could and could not see, when they should be home, how they

Yes

No

 

should act, etc.)?

 

 

MISCELLANEOUS

177.

Have you ever taken a polygraph? If yes, when and where?

Yes

No

 

 

 

 

178.

Have you ever been refused a security clearance? If yes, where, when and why?

Yes

No

 

 

 

 

179.

Have you ever belonged to a subversive or militant group that has advocated the use

Yes

No

of violence or unlawful means to obtain its goals?

180.

Do you have any tattoos? If yes, give description and location.

Yes

No

 

 

 

 

181.

Have you ever been involved in a hazing incident?

Yes

No

 

 

 

 

182.

Are there any actions pending in civil court in which you are a defendant?

Yes

No

 

 

 

 

183.

Is there anything in your background that you have not been asked about that might

Yes

No

 

eliminate you from consideration for this job if it were found out?

 

 

12

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LAW ENFORCEMENT / MILITARY POLICE EXPERIENCE

THOSE APPLICANTS WHO ARE NOW OR HAVE PREVIOUSLY BEEN PEACE OFFICERS, RESERVE PEACE OFFICERS OR MILITARY POLICE OFFICERS MUST ANSWER THE FOLLOWING QUESTIONS.

184.

As a peace officer, have you ever accepted a gratuity?

Yes

No

 

 

 

 

185.

As a peace officer, have you ever accepted anything for overlooking a violation?

Yes

No

 

 

 

 

186.

As a peace officer, have you ever made a false official report?

Yes

No

 

 

 

 

187.

As a peace officer, have you ever used your official position for personal gain?

Yes

No

 

 

 

 

188.

As a peace officer, have you ever withheld evidence seized in the course of your

Yes

No

official duties.

189.

As a peace officer, have you ever had sex on duty?

Yes

No

 

 

 

 

FOR THE FOLLOWING QUESTIONS, INCLUDE: DATES, AGENCY’S NAME, NAMES OF OTHER OFFICERS, LOCATION, CASE NUMBERS, AND A CONTACT PERSON IN CHARGE OF THE INVESTIGATION/COMPLAINT.

190.

Have you ever been the subject of an Internal Affairs investigation?

Yes

No

 

 

 

 

191.

Have you ever had a citizen’s complaint alleged against you?

Yes

No

 

 

 

 

192.

Have you ever had any disciplinary actions taken against you, including suspensions,

Yes

No

demotions, or written and oral reprimands

193.

Have you ever been involved in an incident where it was necessary to use deadly

Yes

No

force, regardless if the person died or not?

I am aware that any false statements or omissions made on this questionnaire will cause my name to be removed from the eligibility list, or be cause for non-selection by the San Bernardino County Sheriff’s Department. I understand that I am subject to termination if discrepancies are discovered after I have been appointed. Additionally, I understand that I am to immediately notify my background investigator of any changes in the above information. Failure to notify the Sheriff’s Background Unit of these changes could also be grounds for disqualification and/or non-selection.

Print Name: _________________________________________________________

Signature: ___________________________________ Date: __________________

Background Investigator: ______________________________________________

Signature: ___________________________________ Date: ___________________

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Step no. 1 of filling out California

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Filling out part 2 in California

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Step # 3 for submitting California

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Learn how to fill in California portion 4

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California conclusion process detailed (portion 5)

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