Custodian Supplemental Questionnaire
QUESTION 1
Are you at least 18 years of age?
QUESTION 2
Are you a citizen of the United States or a lawful, permanent resident, granted refugee or asylee status and authorized to work in the United States?
QUESTION 3
Which best describes your highest level of education?
No High School Diploma or Equivalency
QUESTION 4
How many years of experience do you possess in janitorial or related custodial work?
QUESTION 5
Are you able to lift up to 50 lbs without assistance?
QUESTION 6
Are you willing to work overtime, weekends, nights, and holidays, if necessary?
QUESTION 7
In the last twelve (12) months, have you used marijuana, or its derivative?
QUESTION 8
Have you ever sold, delivered or manufactured a controlled substance?
QUESTION 9
In the last three (3) years, have you illegally used any Schedule I through Schedule V, excluding marijuana, (Schedules I through V, as defined in the Controlled Substances Action, 21 U.S.C., Section 812, include but are not limited to, cocaine, crack. lysergic acid diethylamide (LSD), amphetamines, methamphetamines, heroin, MDMA, GHB and anabolic steroids)?
QUESTION 10
Have you ever illegally used a controlled substance, including marijuana or its derivative, while employed as a law enforcement or corrections officer, while working in a prosecutorial position, or while employed in a position of public safety? (Exception: Any use of marijuana or its derivative while working in the capacity of an undercover operative for the purpose of the investigation)
QUESTION 11
If you answered "Yes", please provide the information listed below or type "N/A" if not applicable. * Drug, how taken, circumstances, number of times illegally obtained/used/supplied/sold. * Date of first time illegally obtained/used/supplied/sold. * Last time illegally obtained/used/sold.
QUESTION 12
Have you ever illegally used any of the following controlled substance in your lifetime? (Please check all that apply. If none, check the last box, "Not applicable".)
Amphetamines such as Uppers/Speed
Opiates such as Opium/Heroin/Oxycodone
Barbiturates such as Downers
Phencyclidine such as PCP/Angel Dust
Benzodiazephines such as Valium/Darvon
Methaqualone such as Quaaludes
LSD such as Acid/Microdots
Any other drug not previously listed
QUESTION 13
Have you ever pled guilty or no contest to, had adjudication withheld, or been convicted of a misdemeanor involving false statements, perjury or domestic violence?
QUESTION 14
Have you ever pled guilty or no contest to, had adjudication withheld, or been convicted of a felony offense?
QUESTION 15
Have you been convicted of a DUI in the last 60 months (5 years)?
QUESTION 16
Have you been convicted of a DUI more than once in your lifetime?
QUESTION 17
Have you engaged in sexual abuse or been convicted, or civilly or administratively adjudicated, of engaging or attempting to engage in sexual activity in the community facilitated by force, overt or implied threats of force, or coercion by a victim who did not consent or was unable to consent or refuse?
QUESTION 18
Have you engaged in sexual abuse in a prison, jail, lockup, community confinement facility, juvenile facility, or other institution (as defined in 42 U.S.C. 1997).
QUESTION 19
In order to conduct a thorough background investigation, you will be required to provide the website(s) and user name(s) for all social media accounts. In addition, you will be required to "friend" our background investigators on Facebook, if applicable. Do you confirm that on this application you have provided the requested information and will provide them access to your personal accounts?
I do not have any social media accounts, personal websites, or blogs.
QUESTION 20
["CUSTODIAN JOB DESCRIPTION": " Are you able to perform the essential functions of the job, with or without reasonable accommodations?]
QUESTION 21
If you answered "No" to the previous question above, please indicate any reasonable accommodation(s) that will assist you in performing the essential functions of the position.
QUESTION 22
Do you have a tattoo in a visible location on the neck, face, scalp, or hands? (Click here to review the Appearance and Grooming Policy(Download PDF reader))
QUESTION 23
Have you registered with Selective Service? (NOTE: Registration is required by all males prior to their 26th birthday. If you are a male age 18-25 and have not yet registered, you must do so here. Females are not required to register at this time and should select 'N/A'.
* Required Question