New Employee Application

Please thorough and fill out every applicable field when completing this application.







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12. In the last 5 years, have you been arrested for, charged with, or convicted of, been imprisoned, been on probation, or been on parole for any offense(s)? Include all offenses where you have been found guilty, pled guilty or nolo contendere (no contest). (Leave out traffic fines of less than $150.00.)

If “YES”, use item 20 to provide the date, explanation of violation, place of occurrence, and the name and address of the police department or court involved.

YesNo

13. Have you been convicted by a military court-martial in the past 5 years?

If “YES”, use item 20 to provide the date, explanation of the violation, place of occurrence, and the name and address of the military authority or court involved.

YesNo

14. Are you now under charges for any violation of law?

If “YES”, use item 20 to provide the date, explanation of violation, place of occurrence, and the name and address of the police department or court involved.

YesNo

15. During the last 5 years, have you been fired from any job for any reason, did you quit after being told that you would be fired, or did you leave any job by mutual agreement because of specific problems?

If “YES”, use item 20 to provide the date, an explanation of the problem, reason for leaving, and the employer’s name and address.

YesNo

16. Have you ever been arrested for or charged with a crime involving a child?

If “YES”, use item 20 to provide the date, explanation of the violation, disposition of the arrest(s) or charge(s), place of occurrence, and the name and address of the police department or court involved.

YesNo

17. Have you ever been found guilty of, or entered a plea of nolo contendere (no contest) or guilty to, any felonious offense, or any of two or more misdemeanor offenses under Federal, State, or tribal law involving crimes of violence; sexual assault, molestation, exploitation, contact or prostitution; crimes against persons; or offenses committed against children?

If “YES,” use item 20 to provide the date, explanation of the violation, disposition of the arrest(s) or charge(s), place of occurrence, and the name and address of the police department or court involved.

YesNo

18. In the last 5 years have you illegally used any controlled substance, for example, marijuana, cocaine, crack cocaine, hashish, narcotics (opium, morphine, codeine, heroin, etc.), amphetamines, depressants (barbiturates, methaqualone, tranquilizers, etc.), hallucinogenics (LSD, PCP, etc.), or illegally used prescription drugs?

If “YES”, use Item 20 below to provide the date(s) of use, identify the controlled substance(s) and/or prescription drugs used, and the number of times each was used. Include any treatment or counseling received.

YesNo

19. In the last 5 years, have you been involved in the illegal purchase, manufacture, trafficking, production, transfer, shipping, receiving, or sale of any narcotic, depressant, stimulant, hallucinogen, or cannabis, for your own intended profit or that of another?

If “YES”, use Item 20 below to provide information relating to the type of substance(s), the nature of the activity, and any other details relating to your involvement with illegal drugs.

YesNo

20.