Attachment 2
Character Questionnaire
Teacher Standards and Practices Commission (TSPC)
Applicant Information
Name ______________________________________________________ Date of birth_______________________
LAST, FIRST MIDDLE INITIAL
TSPC Character Questions
You must answer either “yes” or “no” to each of the following questions; any other response will result in your application being
considered incomplete. All “yes” answers must be fully explained in writing on a separate piece of paper and the explanations must
be signed and dated by you.
1. Have you ever left any educational or school-related employment, voluntarily or involuntarily, while
the subject of an inquiry, review or investigation of alleged misconduct? Have you ever left educational or
school-related employment when you had reason to believe an investigation for misconduct was underway
or imminent?
2. Are you currently the subject of an inquiry, review or investigation for alleged misconduct or alleged
violation of professional standards of conduct by either an employer or a licensure agency?
3. Have you ever been placed on leave by your employer for any alleged misconduct?
4. Have you ever had any adverse action taken on a professional certificate, license or charter school
registration? Have you ever been placed on probationary status for alleged misconduct while holding a
professional license, certificate, registration, or credential?
5. Have you ever been denied any professional license for which you applied or granted a professional
license on a conditional or probationary basis for any alleged misconduct?
6. Have you ever surrendered a professional license of any kind before its expiration?
7. Have you ever been disciplined by any public agency responsible for licensure of any kind, including
but not limited to educational licensure?
8. Have you ever been convicted or been granted a diversion or conditional discharge by any court for
any: (a) Felony; or (b) Misdemeanor; or (c) Major traffic violation including but not limited to: driving
under the influence of intoxicants or drugs; reckless driving; fleeing from or attempting to elude a police
officer; driving while your license was suspended, revoked or used in violation of any license restriction; or
failure to perform the duties of a driver or witness at an accident?
9. Have you ever been arrested or cited for any offense listed in section (8) above which is still pending in
the courts? This includes any diversion, conditional discharge or postponed adjudication that has not been
dismissed by the courts at the time this application is signed.
10. Have you ever had any civil judgment or other court order, including but not limited to a restraining
order, entered against you resulting from allegations of abuse, assault, battery, harassment, intimidation,
neglect, stalking, or other threatening behavior toward other persons?
Your signature and the date
I hereby certify that the information submitted on or relating to this form is true and correct.
______________________________________________________ ________________________________
SIGNATURE DATE
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