Fillable DRUG QUESTIONNAIRE The Drug Enforcement Administration (DEA) is (Department of Justice)

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DRUG QUESTIONNAIRE The Drug Enforcement Administration (DEA) is (Department of Justice)

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DRUG QUESTIONNAIRE
The Drug Enforcement Administration (DEA) is charged with enforcing the Controlled Substances Act
(CSA). Thus, the use of drugs and drug abuse by DEA employees and contractors is not tolerated.
Applicants for DEA employment, and contractor personnel offered on DEA contracts, must disclose their
current and past drug usage and activity. Individuals who are currently using illegal drugs or abusing legal
drugs or substances, will not be selected for employment or be eligible to work on DEA contracts. Some
otherwise qualified applicants may have used illegal drugs, or abused legal drugs or substances, at some
point in their past. The application of DEA's drug use policy guidelines, in conjunction with a case-by-case
analysis, will determine if an applicant's prior drug usage or activity will result in the applicant's non-selection
for employment with the DEA. Absent mitigating circumstances, an applicant will not be selected for
employment if he or she used (or ingested anything containing) marijuana within the three (3) years
preceding the date of the application for employment; or used any illegal drugs other than marijuana, within
the ten (10) years preceding the date of the application for employment. An applicant who deliberately
misrepresents his or her drug history will not be selected for employment.
All applicants for employment with DEA must complete this form and submit it as part of their employment
applications. Indicate the date, if any, on which you last used each substance. With the exception of
Marijuana, do not include any instance in which the substance was prescribed, administered, or dispensed
for you by a duly authorized physician for treatment of a legitimate medical condition. Please include any
Hemp or Cannabidiol (CBD) use, if used before 12/20/2018.
*
DEA will not use, or disclose for use, as
evidence against you in a criminal proceeding, your truthful responses nor information derived from your
truthful responses.
Substances
Approximate
Month/Year You
Last Used/Tried/or
Experimented With
this Substance
Please Initial If
You Have Never Used
Used/Tried/
Experimented
Month Year
Marijuana (Whether Medicinal or Not)*
Hashish/Hash Oil
Cocaine/Crack
Heroin
Fentanyl
PCP
Opium
Methamphetamine
Ecstasy
Any Other Illegal Substance
(Please Identify) _________________________
Prescription Drugs (Not prescribed to applicant)
(Please Identify) _________________________
* As defined at 7 U.S.C. § 1639o(1).
I certify that the information provided on this questionnaire is correct and complete to the best of my
knowledge. I further certify that I was not asked any information concerning use of the substances listed
on this questionnaire other than that contained in the questionnaire. I understand that any misstatement of
fact or omission of information may subject me to disqualification from further consideration in the hiring
process.
________________________
Last Name
________________________
First
____
MI
_____________
Date of Birth
______________________________________
Signature of Applicant
________________________
Date
1
DEA Form 341
OMB No. 1117-0043
Expiration Date: 1/31/2024
(REV 11/2020)
Previous Versions Obsolete
click to sign
signature
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DRUG QUESTIONNAIRE
PRIVACY ACT NOTICE
Providing this information is voluntary. Authorities for the collection of this information are found in 5 U.S.C.
Part II (Civil Service Functions and Responsibilities) and Part Ill (Employees). The principal purposes for
which the information will be used are to evaluate your qualifications and suitability for employment at the
DEA and to ensure the accuracy of agency records. The information may be disclosed to employees of the
U.S. Department of Justice who have a need to know the information for the performance of their duties,
and to appropriate Federal, State, or local agencies responsible for investigating, prosecuting, enforcing,
or implementing a statute, rule, regulation, or order, when DEA becomes aware of an indication of a violation
or potential violation of civil or criminal law or regulation. Failure to furnish the requested information may
disqualify you from employment at DEA.
PAPERWORK REDUCTION ACT NOTICE
See Title 44, United States Code, Chapter 35. This form requires you to disclose your personal history of
illegal drug use, if any. The principal purposes for which the information will be used are to evaluate your
qualifications and suitability for employment at the DEA and to ensure the accuracy of agency records. We
try to create forms and instructions that are accurate, can be easily understood, and which impose the least
possible burden on you to provide us with information. The estimated average time to complete and file this
form is five minutes. If you have comments regarding the accuracy of this estimate, or suggestions for
making this form simpler, you can write to: Human Resources Division, Drug Enforcement Administration,
8701 Morrissette Drive, Springfield, VA 22152. Under the Paperwork Reduction Act, an agency of the
United States government may not conduct or sponsor, and a person is not required to respond to, a request
for collection of information unless it contains a currently valid Office of Management and Budget (0MB)
control number.
2
I
nitials: ______
DEA Form 341
OMB No. 1117-0043
Expiration Date: 1/31/2024
(REV 11/2020)
Previous Versions Obsolete
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Completed 28 January 2022

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