INTEGRITY & LIFESTYLE QUESTIONNAIRE

Transcription

1 INTEGRITY & LIFESTYLE QUESTIONNAIRE Honesty, Integrity and Lifestyle are areas that are scrutinized closely in considering Central Saanich Police Service applications. This questionnaire pertains to your lifestyle and your integrity. It is expected that you answer all questions accurately, completely and honestly. Should you be considered to continue in the process, your answers will be verified by a variety of means including a detailed background investigation, interviews and a Polygraph examination. Please be advised that deceit, dishonesty or non-disclosure concerning questions in this document will result in disqualifying you from this and any future competitions. Last Name: Given Names: Address: City: Province: Postal Code: Telephone: Home: Work: Cell:

2 DRIVING: 1. Do you possess a valid Class 5 British Columbia driver s licence? Yes List all traffic offences with which you have been charged since your driver s licence was issued. 2. Has your drivers licence ever been suspended? Yes - Provide full details regarding why, when and how many times it has been suspended. 3. Have you been involved in a motor vehicle accident in the past five years? Yes - Were you at fault? What were the details of the accident(s)?

3 4. Have you been the driver involved in a hit and run accident? 5. How many times have you driven impaired? 6. When was the last time you drove impaired? ALCOHOL USE: 7. Do you drink alcoholic beverages? Yes - How much and how often (daily, weekly, monthly)? 8. When and why are you most likely to consume alcohol?

4 9. Have you had contact with the police while you were under the influence of alcohol? Yes Provide details. (Where/when/circumstances) 10. Has alcohol ever caused a problem in your job, home, school or community? Yes - When and what were the circumstances? 11. Have you ever been, or are you now dependent on alcohol? Yes Provide details.

5 12. Have you ever been asked to resign or been dismissed from a position because of alcohol related concerns? Yes Provide details (when/where/circumstances). DRUG USE: 13. Have you ever experimented with an illegal street drug? Yes - Which illegal drugs have you experimented with? Marijuana - How many times? When? Hashish - How many times? When? Mushrooms - How many times? When? Cocaine - How many times? When? Heroin - How many times? When? Other Drug (Specify) How many times? 14. Over what period of time did you use illegal drugs? (Be specific)

6 15. When did you last use an illegal street drug? What were the circumstances? 16. Have you ever purchased illegal drugs? Yes - Provide details regarding the purchase and your involvement. 17. Have you ever sold illegal drugs? 18. Have you ever grown/manufactured/imported illegal drugs?

7 19. Have you ever used or sold steroids? 20. Have you ever misused prescription or non-prescription drugs? CREDIT: 21. Have you ever declared bankruptcy?

8 22. Has a collection agency ever been assigned to any of your outstanding debts? 23. Have you ever knowingly written an NSF cheque? Yes Provide details. 24. Have you ever had a problem with debt?

9 INTEGRITY: 25. Have you ever been in a physical altercation with a spouse or partner? (Domestic violence) 26. Have you ever used physical violence toward another adult? (Sports or otherwise) 27. Have you ever retained the services of a prostitute?

10 28. Have you ever retained the services of an escort agency? 29. Have you ever had sexual involvement with anyone without their consent, in this or any other country? 30. Have you ever been involved in a sexual manner with a child or under age person, in this or any other country?

11 31. Have you ever committed a sexual act that if you were caught you would have been prosecuted, in this or any other country? 32. Do you have access to the Internet from either your home or work? 33. What internet sites do you regularly visit?

12 34. What social networking websites do you participate in? i.e. Facebook, MySpace, YouTube etc. ne 35. Have you ever viewed internet sites that display sexually explicit material involving under age persons or children? 36. Have you ever downloaded, printed or shared sexually explicit material involving under age persons or children?

13 37. Have you ever made or caused to be made a false or misleading claim with The Insurance Corporation of BC ( I.C.B.C. ) or any other insurance company? 38. Have you ever made or caused to be made a false or misleading claim with WorkSafe BC? 39. Have you ever been disciplined / documented for inappropriate behaviour at work? Yes - Provide details explaining the behaviour and the action taken.

14 40. Have you been unemployed for extended periods of time? Yes - Provide details explaining how long and why. 41. Have you ever been involved in any criminal behaviour? (Theft, misappropriation, fraud, converting anything to your personal use without authorization). 42. Have you ever been suspended or formally reprimanded by an educational institution? (Include academic suspensions). Yes - What was the nature of the incident, when and what disciplinary action was taken?

15 43. Have you ever had problems with absenteeism or lateness when you were a student or as an employee? Yes - What were the causes of your problems? 44. Have you ever cheated on an exam? Yes - When and where?

16 LIFESTYLE: 45. Are you physically fit? Yes - How do you maintain your physical fitness? 46. Do you currently associate with, or have you in the past associated with, individuals or groups who were engaged in criminal activity?

17 47. Have you in the past or are you currently being treated for any medical or emotional condition that has not been disclosed to the police recruiter, be specific? 48. Do you now associate with or are you connected in any way to any gang or member of a gang? Have you in the past associated or been connected in any way to any gang? Yes Provide details. 49. Do you associate with any known or suspected criminal groups? Yes Provide details.

18 50. Have you ever been checked by the police where information about you was taken down / recorded? Yes Provide details. BACKGROUND: A background check is part of the selection process. It involves a detailed and thorough investigation of your history. 51. Is there any information you wish to add or disclose that you feel the Central Saanich Police should be aware of at this time? Remember, non-disclosure may affect the status of your application. Yes Provide details.

19 52. How did you first hear about the? Internet / website Word of mouth / friend or co-worker Newspaper / Magazine Attended a police information session Attended a career fair Other (specify) Should you have any questions or concerns you are advised to contact the Recruiting Officer. All issues must be disclosed prior to the interviews, Computer Voice Stress Analyzer, or any other written or practical examination as required by the recruiting officer, or disqualification will be considered. DECLARATION I hereby declare that the information provided in this document is complete and accurate. I understand that a false statement may disqualify me from further consideration for employment or result in dismissal should I be appointed as a member of the. It is understood and accepted that I am involved in a competitive selection process and that I may be declined at any stage of the process. I have read and understood the information presented on this document. Signature: Date: