Personnel Evaluation Form (Page 3 of 4) in pdf

The following two questions pertain to the illegal use of drugs or drug activity. You are asked to

answer the questions fully and truthfully, and your failure to do so could be grounds for an adverse

employment decision or action against you, but neither truthful responses nor information derived

from your responses will be used as evidence against you in any subsequent criminal proceeding.

Drug Use - In the past 12 months, have you illegally used any controlled

Yes

X No

substance, including but not limited to marijuana, cocaine, crack cocaine, ecstasy,

hashish, narcotics (opium, morphine, codeine, heroin, etc.), amphetamines,

depressants (barbiturates, methaqualone, tranquilizers, etc.), hallucinogenic

(LSD, PCP, etc.), or have you misused prescription drugs?

Drug Activity - In the past seven years, have you been involved in the illegal

Yes

X No

purchase, manufacture, trafficking, production, transfer, shipment, receipt, or sale

of any controlled substance for your own intended profit or that of another?

Are you now under charges for any violation of law?

X Yes

Date

Department

City

State Description

03/2010 WheatRidge

WheatRidge

Stealing food Ticket.

Police

Have you ever been convicted of a crime, been imprisoned, been on probation, or

X Yes

been on parole?

Date

Department

City

State Description

06/2010 WheatRidge police wheatridge

Stealing food ticket.

I also smoked pot once. I had just gotten

back from fishing and I had a knife in my

Green Backpack, we were playing football

and the police arrived. They got a 'tip'. I also

happend to have a bag of (what is now

almost legal in this state) WEED. I can't

remember if I was 17 or 18.

I also D/L torrents. Movies and Games..

so arrest me.

Are you delinquent on any Federal debt?

Yes

X No

Within the past 5 years, have you been employed by or associated with the Peace

Yes

X No

Corps in any capacity (including as a trainee or volunteer)?

Personnel Evaluation Form Page 3

Related Articles

Related forms

Related Categories