10
USE OF ALCOHOL
NOTE: In question #39 the word "drink" means one time or more, including experimentation.
39. Do you drink alcoholic beverages?
☐
☐
PRIOR CRIMINAL CONDUCT
Answer all of the following questions completely and accurately. Any falsification or misstatement of
facts may be sufficient to disqualify you from certification.
NOTE: The word "used" in the following questions includes even one time use or experimentation.
Applicants for the position of Justice Officer must disclose all prior criminal conduct.
40. Have you ever used any illegal drugs including but not limited to marijuana, synthetic or designer drugs, steroids,
opiates, pills, heroin, cocaine, crack, LSD, etc., to include even one time use or experimentation?
☐Yes ☐No
(If YES, specify the circumstances, drugs used, and when the usage last occurred.)
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
41. Have you ever used prescription drugs other than under the supervision or as prescribed by a physician to include
even one time use or experimentation?
☐ Yes ☐No (If YES, specify what drug(s), how and from whom you
received the drug(s), and when the usage last occurred).
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
42. Have you ever purchased, possessed, manufactured, grown, delivered or sold any amount of illegal drugs or controlled
substances for which you did not have a valid prescription.
☐Yes ☐No (If YES, please identify the drug(s) and
provide details concerning the purchase, possession, manufacture, growth, delivery or sale.)
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
43. Have you ever had a Domestic Violence Protective Order or Civil No Contact Order issued against you? (Include both
ex-parte domestic violence protective orders and those entered subsequent a hearing.)
☐ Yes ☐No
(If YES, complete the following and provide documentation of the initial allegations and the judge's findings at
the hearing where both parties were present.)
Date of Issuance County of Issuance:
Name of Plaintiff:
Date of Expiration: