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To be eligible for employment you must successfully pass a background investigation and meet established standards set by Blaine County Emergency Communications and the Idaho Peace Officers Training Academy (POST). The Personal History Questionnaire is required to begin this process. Please complete and return this form promptly. Notarization is required on the Personal Inquiry Waiver. Your answers will be verified through a detailed background investigation and interview assessment. It is to your advantage to BE ABSOLUTELY TRUTHFUL in answering all questions. Any falsification or omission of information will result in the disqualification of your application. Instructions: Answer the following questions regardless of whether the incident may have been sealed, expunged, or dismissed. If the answer to any of the questions below is yes, explain in detail in the Comment Section.

1. As a juvenile or as an adult have you ever committed an offense where you could have been/or were arrested? If yes, give the date the offense was committed, what the offense was and disposition of the charge.*

Yes

No

2. Have you ever petitioned any court to seal or expunge a criminal or juvenile record?*

Yes

No

3. Have you ever been involved in or arrested for any crime of unlawful sexual conduct, stalking or employing physical or domestic violence of any kind?*

Yes

No

4. Have you ever been the subject of an investigation dealing with the theft of something? If yes, what was taken, what was the value and when did this occur?*

Yes

No

5. Have you ever purchased an item(s) that you knew or suspected was stolen? If yes, list item, quantity, value, and date of purchase.*

Yes

No

6. Have you ever had a criminal warrant or a traffic warrant issued for your arrest? If yes, give the date the warrant was issued and date cleared.*

Yes

No

7. Do you reside or associate with anyone (family or friends) who is or has been involved in, charged with or convicted of a misdemeanor or felony? If yes, please list details.*

Yes

No

8. Have you ever been placed on probation or parole? If yes, when, and where.*

Yes

No

9. Have you ever failed a polygraph examination? If yes, when, where, why, and dates.*

Yes

No

10. Have you ever falsified an insurance claim, income tax return or collected unemployment/welfare benefits that you were not entitled to? *

Yes

No

11. Have you ever fraudulently misused a credit card or forged a check? *

Yes

No

12. Have you ever, or are you currently involved in a civil lawsuit?*

Yes

No

13. Has there ever been any situation in which you have been involved which may be incompatible with the duties of an Emergency Communications Officer (ECO)? This would include any activity which may impair your independence of judgment or action in the performance of the duties of an ECO. If yes, explain.*

Yes

No

14. Has your driver’s license ever been suspended, revoked, placed on probation or have you ever received a warning notice from the state who issued your license?*

Yes

No

15. Have you ever been refused a driver’s license by any state? If yes, give the state, date and the circumstances.*

Yes

No

16. Have you ever possessed any drugs, narcotics or other controlled substances other than those prescribed by a doctor or other licensed medical practitioner?*

Yes

No

17. Have you ever illegally purchased, sold or otherwise distributed any drugs, narcotics or other controlled substances?*

Yes

No

18. Have you ever been involved in the cultivation of marijuana or the manufacturing of any drugs, narcotics or other controlled substances?*

Yes

No

19. Have you ever knowingly stored or transported illegal drugs, narcotics or other controlled substances for yourself or another person?*

Yes

No

20. Have you ever tried, ingested, experimented or used illegal drugs? This includes as a juvenile or even one (1) experimental use. (Please note answering affirmative to this question does not automatically exclude you from employment. See minimum standards on pg. 3) If yes, explain, what types, how often and date of the last occurrence. *

Yes

No

21. Do you drink alcohol? If yes, how much and how frequent?*

Yes

No

22. Have you ever had a drug or alcohol-related accident?*

Yes

No

23. Have you ever been convicted or pled guilty to driving while under the influence of alcohol or drugs, or to lesser charges following a D.U.I. arrest? If yes, list the date of the arrest, the law enforcement agency involved, and the final disposition?*

Yes

No

24. Have you or your spouse: Ever defaulted on any loan, debt or obligation in the past five years? Ever had your wages attached or garnished? Ever been refused credit? Ever had any collection or repossession action taken against you? Ever filed a petition for bankruptcy? When? Ever had a check bounce or returned for insufficient funds? If yes to any, please explain circumstances on the comment section provided below.*

Yes

No

25. Have you ever been involved in any domestic violence? If yes, explain in the comment section provided below.*

Yes

No

26. Do you have any issues or problems losing your temper or with anger management?*

Yes

No

27. Do you have any issues or problems with honesty, reliability, integrity or moral character?*

Yes

No

28. Have you ever perjured yourself in a court of law?*

Yes

No

29. Would you object to taking a polygraph screening?*

Yes

No

32. Have you purposely omitted any information from your employment application? *

Yes

No

If the answer to any of the questions above is yes, please explain in detail on this comment section. Please reference the question number in your response. Otherwise please mark this section with N/A.*

NOTE: A CONVICTION MAY NOT NECESSARILY DISQUALIFY YOU FROM EMPLOYMENT. THE CIRCUMSTANCES AND FACTS SURROUNDING THE OCCURRENCE(S) AND THE DEGREE OF RELEVANCE TO THE JOB YOU ARE APPLYING FOR WILL BE TAKEN INTO CONSIDERATION.

If the answer to any of the questions below is yes, explain in detail in the Comment Section.

33. Have you ever worked for any law enforcement agency in any capacity? If yes, list agency name, dates, job title and status.*

Yes

No

34. Are you currently or have you in the past been POST certified? If yes, list the type of certificate, agency name, state, highest level attained and date awarded.*

Yes

No

35. Have you ever served in the U.S. Military? If yes, list dates, the branch of service, type of discharge and highest rank held.*

Yes

No

36. Has any supervisor ever reprimanded you for being late or absent? *

Yes

No

37. Has any supervisor ever reprimanded you for misconduct or not doing your job properly?*

Yes

No

38. Have you ever been terminated during the probationary period from any employment?*

Yes

No

39. Have you ever been suspended, fired, or asked to resign from any employment?*

Yes

No

40. Have you ever quit a job without giving proper notice?*

Yes

No

41. Have you ever been rejected for employment for any reason by any law enforcement agency? If yes, list which agency and why on the comment page.*

Yes

No

42. Would contacting your current employer during the background investigation present a problem for you?*

Yes

No

Use this section to provide any additional information you may need in answering the questions listed in this application that require detailed answers. List the corresponding question number next to each answer. Should you need additional space, upload any additional documents. If you do not need to provide any additional information simply put an N/A in this section.

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