Fillable Lexington Division of Community Corrections (Lexington-Fayette Urban County Government)

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Lexington Division of Community Corrections (Lexington-Fayette Urban County Government)

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BROWSE LEXINGTON-FAYETTE URBAN COUNTY GOVERNMENT (KY) FORMS

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1
Instructions to the applicant:
Lexington Division of
Community Corrections
RECRUIT
APPLICANT
BACKGROUND
BOOKLET
The information you provide in this Background Investigation Booklet will be used in the background
investigation to assist in determining your suitability for the position of Lexington Corrections Officer.
Type in your responses to all the items and questions. If a question does not apply to you, write “N/A”
(not applicable) in the space provided for your response. If you cannot obtain or remember certain
information, indicate so in your response.
If you need more space for any response, use the last page of this form and identify the additional
information by the question number.
You must save this document to your desktop and follow the instructions on the last page of this booklet
(Booklet Filing Instructions) to turn the completed document into the Backgrounds Unit.
2
Contact Information:
Name of Applicant:
Last First MI
Nicknames or Aliases:
Address: Apt #:
City: State: Zip:
Home Phone #: Cell #: Alternate #:
Primary Email: Secondary Email:
Personal Data:
Date of birth (mm/dd/yyyy):
Are you a United States citizen? Yes No
Age: SS#:
If you are not a United States citizen, have you applied for citizenship? Yes No
Race:
Explain:
Marital Status: Explain:
Gender: Ht:
Wt: Hair color: Eye color:
Driver License State: Driver License #: Exp. Date:
Education:
High School:
Year of Graduation:
Location:
Current/Most Recent College: City/State:
Degree: GPA:
Second Most Recent College: City/State:
Degree: GPA:
3
Trade, Vocational or Technical School Education:
You will be required to furnish transcripts, diploma or other proof to support all your educational claims.
Last Attended College: ___________________________________________________________________
Dates Attended: _________________________________ to _____________________________________
Address: ______________________________________________________________________________
City: ________________________________ State: ________________________ Zip: _______________
Phone#: _________________________________
Degree earned and type of degree: _________________________________________________________
If no degree earned, enter the number of credit hours: __________________________
College: ___________________________________________________________________
Dates Attended: _________________________________ to _____________________________________
Address: ______________________________________________________________________________
City: ________________________________ State: ________________________ Zip: _______________
Phone#: _________________________________
Degree earned and type of degree: _________________________________________________________
If no degree earned, enter the number of credit hours: __________________________
College: ___________________________________________________________________
Dates Attended: _________________________________ to _____________________________________
Address: ______________________________________________________________________________
City: ________________________________ State: ________________________ Zip: _______________
Phone#: _________________________________
Degree earned and type of degree: _________________________________________________________
If no degree earned, enter the number of credit hours: __________________________
4
Academic Information:
Have you ever had academic discipline, been suspended or expelled from any high school, college/university,
business or trade school or police academy? Yes No
If yes, please explain.
Please list any organizations, social or education, that you have taken part in while in school (include high
school as well).
Please list any sport you have played for any school, high school or college and the years you took part in this
or these sports. Please include the name of the school as well.
5
Relatives:
If the relative is deceased, just type “Deceased” in the name section. If you do not have the listed relative,
type “N/A” (not applicable) in the name section.
Father’s Full Name:
Address:
City:
State:
Zip:
Home Phone #:
Work Phone #:
Email Address:
Mother’s Full Name:
Address:
City:
State:
Zip:
Home Phone #:
Work Phone #:
Email Address:
Step-Mother’s Full Name:
Address:
City:
State:
Zip:
Home Phone #:
Work Phone #:
Email Address:
Step-Father’s Full Name:
Address:
City:
State:
Zip:
Home Phone #:
Work Phone #:
Email Address:
Father-in-Law’s Full Name:
Address:
City:
State:
Zip:
Home Phone #:
Work Phone #:
Email Address:
6
Mother-in-Law’s Full Name:
Address:
City:
State: Zip:
Home Phone #: Work Phone #:
Email Address:
Brother’s Full Name:
Address:
City:
State: Zip:
Home Phone #: Work Phone #:
Email Address:
Brother’s Full Name:
Address:
City:
State: Zip:
Home Phone #: Work Phone #:
Email Address:
Brother’s Full Name:
Address:
City:
State: Zip:
Home Phone #: Work Phone #:
Email Address:
Sister’s Full Name:
Address:
City:
State: Zip:
Home Phone #: Work Phone #:
Email Address:
Sister’s Full Name:
Address:
City: State: Zip:
Home Phone #: Work Phone #:
7
Email Address:
Sister’s Full Name:
Address:
City:
State: Zip:
Home Phone #: Work Phone #:
Email Address:
Spouse/Significant Other:
Spouse’s/Domestic Partner’s Full Name:
Address:
City:
State:
Zip:
Home Phone #:
Cell Phone #:
Personal Email Address:
Place of Employment:
Position Held:
Place of Employment Address:
City: State: Zip:
Work Phone #: Work Email Address:
DOB: Age: Gender:
Race:
Hair Color:
Eye Color:
How long have you known your spouse/domestic partner?
Is there, or has there ever been, a domestic violence order or restraining order in effect for this individual?
Yes No
If yes, please explain:
8
Children:
List all of your living children, including natural, adopted, step and/or foster care. Include any other
children who reside with you. Provide the name and contact information of the other parent with which
you have the child.
Child’s Full Name:
Address:
City:
State: Zip:
Home Phone #: Cell Phone #:
Other Parent:
Race: Age: Gender:
Natural Adopted Step Foster Other
Employer/School Attending:
Child’s Full Name:
Address:
City:
State: Zip:
Home Phone #: Cell Phone #:
Other Parent:
Race: Age: Gender:
Natural Adopted Step Foster Other
Employer/School Attending:
Child’s Full Name:
Address:
City:
State: Zip:
Home Phone #: Cell Phone #:
Other Parent:
Race: Age: Gender:
Natural Adopted Step Foster Other
Employer/School Attending:
9
Child’s Full Name:
Address:
City:
State:
Zip:
Home Phone #:
Cell Phone #:
Other Parent:
Race:
Age:
Gender:
Natural Adopted Step Foster Other
Employer/School Attending:
Military Service:
Have you ever served in a military organization? Yes No
Current Military Branch
Branch:
Highest Rank Held:
Last M.O.S.:
Type of Discharge:
Dates of Service (by year): From
to
Supervisor’s Name:
Last Supervisor’s Phone #:
Past Military Branch
Branch:
Highest Rank Held:
Last M.O.S.:
Type of Discharge:
Dates of Service (by year): From
to
Supervisor’s Name:
Last Supervisor’s Phone #:
Past Military Branch
Branch:
Highest Rank Held:
Last M.O.S.:
Type of Discharge:
Dates of Service (by year): From
to
Supervisor’s Name: Last Supervisor’s Phone #:
10
Military Service:
List all military awards you have received.
List any certifications received in the military.
List any discipline you received and the outcome of that discipline.
List any reasons for leaving one military organization to join another.
11
Employment:
Most recent job first!
Company Name:
Address:
City:
State:
Zip:
Supervisor:
Title:
Supervisor’s Phone #:
Last Position Held:
Date of Employment (month/year): From
to
Reason for separation, if no longer employed at this company:
Laid Off Resigned Fired
Other (explain in 100 words or less):
Please explain your position at this employer and what you did on a daily basis.
Please explain any issues at this employer regarding your involvement in sexual harassment, inappropriate
actions, any disciplinary actions, theft, poor attendance or reasons for being fired or laid off.
12
Company Name:
Address:
City:
State:
Zip:
Supervisor:
Title:
Supervisor’s Phone #:
Last Position Held:
Date of Employment (month/year): From
to
Reason for separation, if no longer employed at this company:
Laid Off Resigned Fired
Other (explain in 100 words or less):
Please explain your position at this employer and what you did on a daily basis.
Please explain any issues at this employer regarding your involvement in sexual harassment, inappropriate
actions, any disciplinary actions, theft, poor attendance or reasons for being fired or laid off.
13
Company Name:
Address:
City:
State:
Zip:
Supervisor:
Title:
Supervisor’s Phone #:
Last Position Held:
Date of Employment (month/year): From
to
Reason for separation, if no longer employed at this company:
Laid Off Resigned Fired
Other (explain in 100 words or less):
Please explain your position at this employer and what you did on a daily basis.
Please explain any issues at this employer regarding your involvement in sexual harassment, inappropriate
actions, any disciplinary actions, theft, poor attendance or reasons for being fired or laid off.
14
Please list any other jobs you may have had prior to the last job listed. Please include the business name,
address, telephone number and supervisor’s name.
Have you ever quit a job without proper notice? Yes No
If yes, please explain.
Have you ever resigned in lieu of termination? Yes No
If yes, please explain.
Have you ever been accused of discrimination (e.g. sexual harassment, racial bias, sexual orientation
harassment, etc.) by a co-worker, superior, subordinate or customer? Yes No
If yes, please explain.
Were you ever the subject of a written complaint at work? Yes No
If yes, please explain.
Have you ever been counseled at work due to lateness or absences? Yes No
If yes, please explain.
15
Have you ever received an unsatisfactory performance review? Yes No
If yes, please explain.
Have you ever sold, released or given away legally confidential information? Yes No
If yes, please explain.
Have you ever called in sick to work when you were neither sick nor caring for a sick family member?
Yes No
If yes, how many sick days have you used in the past five years which were not due to illness? Please explain.
In the past three years, have you missed work or been late to work due to drug or alcohol consumption?
Yes No
If yes, please explain.
Has your work performance ever been affected by your use of alcohol or drugs? Yes No
If yes, please explain.
16
In the past three years, have you been warned by an employer about your drinking or drug habits and their
impact on your performance? Yes No
If yes, please explain.
Have you ever applied to any other law enforcement agency? Yes No
If yes, list EVERY agency you have applied to, starting with the most recent. If more space is needed, continue
on the last page of this booklet.
Name of Agency:
Address:
City:
State:
Zip:
Phone #:
Date Applied:
Background Investigator’s Name (if known):
Check each step in the process you completed and your current status:
Steps
Application Written Physical Agility Oral Interview
Polygraph Background Chief’s Oral Interview Medical
Status
Hired On List Withdrawn Disqualified
Please explain if you did not get selected or withdrew from the process.
17
Name of Agency:
Address:
City:
State:
Zip:
Phone #:
Date Applied:
Background Investigator’s Name (if known):
Check each step in the process you completed and your current status:
Steps
Application Written Physical Agility Oral Interview
Polygraph Background Chief’s Oral Interview Medical
Status
Hired On List Withdrawn Disqualified
Please explain if you did not get selected or withdrew from the process.
Name of Agency:
Address:
City:
State:
Zip:
Phone #:
Date Applied:
Background Investigator’s Name (if known):
Check each step in the process you completed and your current status:
Steps
Application Written Physical Agility Oral Interview
Polygraph Background Chief’s Oral Interview Medical
Status
Hired On List Withdrawn Disqualified
Please explain if you did not get selected or withdrew from the process.
18
Residential Information:
List your current address and then list previous addresses for the past five years as well as the length of
time you resided at each location.
Current Home Address:
City:
State:
Zip:
Home Phone #:
Years at this Address (month/year) From
to
Rent Own
List the names and associations of all persons residing within this address and contact telephone numbers for
each:
1. Phone #:
Parent Spouse Child Sibling Other
2. Phone #:
Parent Spouse Child Sibling Other
3. Phone #:
Parent Spouse Child Sibling Other
4. Phone #:
Parent Spouse Child Sibling Other
5. Phone #:
Parent Spouse Child Sibling Other
19
1st Former Home Address:
City:
State:
Zip:
Home Phone #:
Years at this Address (month/year) From
Rent Own
to
2nd Former Home Address:
City:
State:
Zip:
Home Phone #:
Years at this Address (month/year) From
Rent Own
to
3rd Former Home Address:
City:
State:
Zip:
Home Phone #:
Years at this Address (month/year) From
Rent Own
to
Have you ever been evicted or asked to leave a residence? Yes No
Have you ever left a residence owing rent? Yes No
If yes, please explain.
20
Traffic Violations:
List all citation traffic violations. This includes out-of-state violations as well!
Violation Date (mm/dd/yyyy) State Disposition
List all states in which you have been issued a driver license.
State Driver License #
Has your driver license ever been suspended in any state for any reason? Yes No
If yes, please explain.
List any vehicle accidents in which you were at fault.
Date (mm/dd/yyyy) Location Brief Description
21
Alcohol Use/History:
Have you operated a motor vehicle while intoxicated in the past 24 months? Yes No
If yes, how many times?
Please explain.
Have you been intoxicated in public in the last 24 months (2 years)? Yes No
If yes, how many times?
Please explain.
When was the last time you were intoxicated and why?
Have you ever been arrested or received a citation for an alcohol related offense? Yes No
If yes, explain the nature of the arrest/citation, including the date, circumstances of the offense and the final
outcome.
22
Arrest History:
Have you ever been arrested? Yes No
If yes, please provide the following information:
Date (mm/dd/yyyy) Location (including state) Offense Disposition
Have you ever been arrested for a domestic violence related offense or felony? Yes No
If yes, please explain and include the circumstances of the arrest or charge, the dates in which the actions took
place and the outcome of the case(s).
Have you ever had an emergency protective order or other domestic violence related protection order against
you? Yes No
If yes, please explain and include the circumstances in which the order was taken out, the dates in which the
actions took place and the outcome of the case(s).
23
Illegal Drug History:
Please complete the following table.
Drug Used
Date of First
Use
(mm/dd/yyyy)
Date of Last
Use
(mm/dd/yyyy)
Maximum
Times Used
How Drugs
Were Used
Number of
Times
Purchased
Marijuana
Hashish
PCP
Angel Dust
Amphetamines
LSD
Peyote
Mescaline
Heroin
Cocaine
Quaaludes
Downers
Tranquilizers
Percocet
Hydrocodone
Ecstacy/XTC
Darvocet
Dilaudid
Ketamine
Speed
Inhalents
Meth.
Mushrooms
Xanax
Adderall
Oxycodone
Ambien/Lunesta
Anabolic Steroids
Synthetic Cannabinoids
Bath Salts
24
Please complete the following table.
Type of Drug
Amount Sold
Date
(mm/dd/yyyy)
Number of Times
Dollar Value
Have you ever taken someone else’s pain medication or over-the-counter medication? If so, what were the
circumstances to taking that medication? Please explain.
Please provide any additional information regarding your previous or current drug use that you believe would
be important for us to know during this selection process.
25
Prior Polygraph Examinations:
Prior Polygraph Examination #1:
When:
Where (location test was taken): ______________________________________________________________
Why:
Who (name of examiner or agency):
Prior Polygraph Examination #2:
When:
Where (location test was taken): ______________________________________________________________
Why:
Who (name of examiner or agency):
Prior Polygraph Examination #3:
When:
Where (location test was taken): ______________________________________________________________
Why:
Who (name of examiner or agency):
If more than three polygraph examinations, check here
26
Criminal History Questions:
Please complete the following questions.
1. Have you ever taken the life of another person either intentionally or accidentally? Yes No
If yes, please explain.
2. Have you ever taken part in the act of rape, either by force or threats of injury? Yes No
If yes, please explain.
3. Have you ever taken part in any act involving hurting, harming, abusing, striking or injuring any person
under the age of 15? Yes No
If yes, please explain.
4. Have you ever taken part in any act involving the intentional damage or destruction of any property
belonging to another person? Yes No
If yes, please explain.
5. Have you ever taken part in abducting another person? Yes No
If yes, please explain.
6. Have you ever been married to two or more people at the same time? Yes No
If yes, please explain.
27
7. Have you ever taken part in any act of entering or remaining on the property of another, knowing that you did
not have permission of the owner? Yes No
If yes, please explain.
8. Have you ever taken part in any act involving the use of a firearm, knife, club or other deadly weapon;
physical force, threats or intimidation in order to steal cash or property; or with the intent of committing another
criminal act? Yes No
If yes, please explain.
9. Have you ever taken part in any act involving hurting, harming or attempting to injure another person using a
firearm, knife, club or any other deadly weapon? Yes No
If yes, please explain.
10. Have you ever had any sex act after you turned 18 years of age with another person who was less than 14
years of age at the time of the act (examples: intercourse, oral sex or the touching of the breasts, genitals or anus
of another person)? Yes No
If yes, please explain.
11. Have you ever exposed your anus or genitals in public to sexually arouse or to gratify another person?
Yes No
If yes, please explain.
12. Have you ever filed a false police report? Yes No
If yes, please explain.
28
13. Have you ever taken part in the theft of any vehicle, the use of any vehicle, or, joy-riding in/on a vehicle
without the owner’s permission? Yes No
If yes, please explain.
14. Have you ever unlawfully possessed an explosive device, sawed off shotgun or rifle, machine gun, armor
piercing ammunition or silencer? Yes No
If yes, please explain.
15. Have you ever carried a pistol, switchblade knife or any other illegal weapon? Yes No
If yes, please explain.
16. Do you have any debts to friends, family, employers or any other person as a result of any act of gambling?
Yes No
If yes, please explain.
17. Have you ever been involved in or participated in any activity, which resulted in a police investigation,
arrest and/or incarceration (this does not include traffic offenses, but does include any instance where charges
were filed, warrants issued and/or bond posted)? Yes No
If yes, please explain.
29
18. Have you ever taken part in any act involving gambling (this includes, but is not limited to, placing a wager
or bet to a bookmaker by phone or by hand on the results of any sport or by being “paid off” while playing an
illegal slot or video poker machine)? Yes No
If yes, please explain.
19. Have you ever taken or kept a child under the age of 18 out of the state in which the child resides, to violate
a court order or judgment disposing of the child’s custody? Yes No
If yes, please explain.
20. Have you ever caused, planned or started a fire or an explosion to damage or destroy a building, habitation
or vehicle belonging to you or another person, which was insured? Yes No
If yes, please explain.
21. Have you ever committed acts of cruelty to any creature or animal, which resulted in harm, injury or death
(excludes legally licensed hunting or fishing)? Yes No
If yes, please explain.
22. Have you ever been involved in the telling of a lie, falsehood or any misrepresentation while under oath or
on a sworn notarized statement? Yes No
If yes, please explain.
30
23. Have you ever been involved in resisting arrest or interfering with any police officer in making an arrest or
detention? Yes No
If yes, please explain.
24. Have you ever been a part of any sexual act, including, but not limited to, intercourse, oral or anal sodomy
or any sexual contact with another person in exchange for cash or property of any value (include Nevada or
other countries where prostitution is legal)? Yes No
If yes, please explain.
25. Have you ever fled from police by foot, vehicle or any means to avoid arrest, detention or questioning?
Yes No
If yes, please explain.
26. Have you ever been a part of any act involving forgery or counterfeiting or any writing, document,
signature, money, license, contract, credit card receipt, security agreement, will, deed or any deed of trust with
the intention to defraud or harm the person or business? Yes No
If yes, please explain.
27. Have you ever bribed or attempted to bribe any governmental officer or employee? Yes No
If yes, please explain.
31
28. Have you ever been a part of impersonating a police officer, peace officer or any member of a law
enforcement agency or other governmental agency? Yes No
If yes, please explain.
29. Have you ever taken part in any action in which you were compensated money or anything of value for any
act or prostitution committed by another by force or by threat of force to that person? Yes No
If yes, please explain.
30. Have you ever been a part of stealing of a credit card, presenting a credit card to obtain goods or services
fraudulently or using a credit card without the permission of the person to whom the card was issued, using a
fictitious card or number, any involvement in the manufacture of counterfeit credit card(s), buying credit
card(s), or selling credit card(s) or in any way using a credit card to commit theft or any other crime?
Yes No
If yes, plea
se explain.
31. Have you ever broken into a coin operated device with the intent to steal cash, property and merchandise or
to obtain services? Yes No
If yes, please explain.
32. Have you ever broken into or entered a vehicle of any kind with the intent to steal cash, property or
merchandise (this includes, but is not limited to, car, trucks, trailers, boxcars, vans or motor homes)?
Yes No
If yes, please explain.
32
33. Have you ever been involved in any type of the breaching of peace (this includes, but is not limited to,
profane, vulgar or abusive language to incite a crowd, fighting or threatening another in a public place or
looking into a window or opening in a building for lewd purposes)? Yes No
If yes, please explain.
34. Have you ever been involved in, whether alone or as a participant in a group/organization which seeks to
further murder, arson, robbery, burglary, theft, kidnapping, assault, forgery gambling, prostitution, promotion or
the distribution of drugs, promotion or distribution of obscene material or any other criminal act?
Yes No
If yes, please explain.
35. Have you been involved in any act of breaking into a building, habitation or any portion of a habitation or
building with the intent to steal cash, property or merchandise or with the intent of committing another criminal
act? Yes No
If yes, please explain.
36. Have you unlawfully deprived an individual of property, cash or merchandise through appropriation, theft,
theft by false pretense, theft from a person, swindling, passing a worthless check, embezzlement or extortion
(this includes making false insurance claims)? Yes No
If yes, please explain.
37. Have you been involved in the production, sale, distribution, promotion or possession with the intent to sell
any picture, magazine, film, video or any item that patently depicts any sexual act (this includes any form of
copulation, masturbation, excretory functions, sadism, masochism or bestiality)? Yes No
If yes, please explain.
33
38. Have you taken part in any sexual acts, after you were 21 years of age, with a person who was less than 16
years of age at the time of the act? Yes No
If yes, please explain.
39. At any time did you lie during this hiring process? Yes No
If yes, please explain.
40. Have you ever assaulted another person by striking them with the intent to hurt that person (this includes
any act of domestic violence, being served with an Emergency Protective Order (EPO), Domestic Violence
Order (DVO) or any other court order)? Yes No
If yes, please explain.
41. Have you ever been involved in any incestuous act of knowingly inflicting sexual contact or sexual
penetration (this includes, but is not limited to, sexual intercourse, oral and anal intercourse with a natural child,
stepchild or child by adoption; natural grandmother, step-grandchild or grandchild by adoption; sister or half-
sister, brother or half-brother, niece or nephew)? Yes No
If yes, please explain.
42. Have you ever made annoying or obscene telephone calls? Yes No
If yes, please explain.
34
43. Have you committed any act that you believe, if it comes out, would bring dishonor to you or the
Lexington Division of Community Corrections? Yes No
If yes, please explain.
44. Have you ever been refused a permit to carry a concealed weapon? Yes No
If yes, please explain.
45. Are you now, or have you ever been, a member or associate of a criminal enterprise, street gang, or any
other group that advocates violence against individuals because of their race, religion, political
affiliation, ethnic origin, nationality, gender, sexual preference or disability? Yes No
If yes, plea
se explain.
Please explain any other type of criminal activity or questionable activity that you have engaged in below OR
use this section to continue explaining one of the previously asked questions from this
section.
33
34
Applicant Interview Questions:
1. What do you consider to be your personal strengths?
2. What do you believe are your personal weaknesses?
3. Describe how you manage your personal finances (e.g. are you in debt, do you spend above your means,
etc.)?
4. What do you consider to be good traits for a Corrections Officer?
5. Why do you want to become a Lexington Corrections Officer?
35
6. Have you ever applied for employment with this department in the past? If yes, list the date and why you
weren’t considered for employment.
7. How did you learn about the Lexington Division of Community Corrections job openings (e.g.
television, internet, radio advertisements)?
8. How would you describe your ability to communicate with people? Please explain.
9. Explain your personal work ethic.
36
10. Describe your ability to work under pressure.
11. Describe any past experience you may have had as a member of a team.
12. What accomplishments in your life are you most proud of?
13. What does the Lexington Division of Community Corrections have to offer you?
37
14. Why do you feel you are the most qualified person for this position?
15. Do you personally, socially or otherwise, know any members of the Lexington Division Community
Corrections? If yes, who are they and how do you know them?
16. Please list any organizations or activities that you engage in (professionally or socially)?
38
/month
Financial Information:
For each of the following questions, please fill in the amounts to the nearest
dollar. Fr
om your employer, what is your take-home monthly income? $
Do you have income other than from your salary or wages? Yes No
If yes, please explain and provide the amount.
Funding Source_______________________________________ $______________/month
Funding Source _______________________________________ $______________/month
Have you ever filed for, or declared, bankruptcy (Chapter 7, 11 or 13)? Yes No
Have any of your bills ever been turned over to a collection agency? Yes No
Have you ever had purchased goods repossessed? Yes No
Have your wages ever been garnished? Yes No
Have you ever been delinquent on income or other tax payments? Yes No
Have you ever failed to file or cheated/lied on an income tax form?
Yes No
Have you ever had an employment bond refused? Yes No
Have you ever avoided paying any lawful debt by moving away? Yes No
Have you ever defaulted on, failed to pay, a loan? Yes No
Have you ever borrowed money to pay for a gambling debt? Yes No
Have you ever spent money for illegal purposes (e.g. drugs, etc.)? Yes No
Have you ever failed to make or been late on court-ordered payments (child support, restitution, alimony)?
Yes No
Have you ever written three or more bad checks in a one-year period? Yes No
If you answered yes to any of the financial questions, please explain.
39
Honesty Certification:
I do hereby certify that all statements made in this questionnaire/booklet are true, complete and correct to the
best of my knowledge, belief and are made in good faith. I understand that any false information, misstatement
or omission of material fact may disqualify me or result in my dismissal from the Lexington Division of
Community Corrections Selection Process.
Type Name Date
40
Booklet Filing Instructions
This entire booklet must be returned to the Backgrounds Unit by email. The booklet is in Adobe
Acrobat. If you do not have Adobe Acrobat, you can download the software for free at the web
address below. After you open the document, you can save it to your computer or storage device by
going to File in the top left hand corner, Save As, PDF and Save. The document can be edited and
saved as many times as necessary.
Once you have completed the document, compose a new email to
correctionsrecruiting@lexingtonky.gov. You must place your last name, first name and middle
name on the subject line. Next, attach the document to the email. After placing any information
that you feel necessary in the body of the email, send it. Make sure your document is attached. Do
not send more than one email with this document attached. Since each contact that is made
between you and the Lexington Division of Community Corrections is part of your background, it is
imperative that you follow all instructions and directions.
http://get.adobe.com/reader/
If you have any questions, call 859-425-2617 and one of the Background Unit detectives will assist
you.
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Lexington Division of Community Corrections (Lexington-Fayette Urban County Government)

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Completed 3 August 2020

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