Maricopa County Sheriff’s Office
Paul Penzone, Sheriff
Other Names Used (including maiden name)
Full Street Address
City
State
Zip
Cell Phone #
E-MAIL ADDRESS (required)
_________________________________________________________________________________________@_____________________________________
Age: ___________ Race:
_x__:__----
F
__________________________________
Date of Birth: _________________
Social Security Number:
Current Driver’s License Number:
_____________________________________
State:
________________
Expiration Date:
List all states/countries you have been licensed
to drive a motor vehicle in the past:
________________________________________________________
PUBLIC DISCLOSURE OF INFORMATION
Your Social Security Number is requested for identification and record keeping purposes. Disclosure of your social security
number is for the purpose of conducting a thorough background investigation. The information included on this form may
constitute a “public record of matter” requiring public disclosure under Arizona’s Public Records Law, A.R.S. 39-121 et.seq.
Signature_______________________________________________________________________
Date________________________
The following information is required so the Sheriff’s Office can conduct a criminal
history records check and a Motor Vehicle Department records check.
Check all PREVIOUS positions applied
for with the Maricopa County
Sheriff’s Office.
_____________ ______________
_____________ ______________
_____________ ______________
_____________ ______________
Detention Officer
Deputy Sheriff
Reserve Deputy
Posse
Deputy Lateral
_____________ ______________
LAST NAME
FIRST NAME
MIDDLE NAME
Place of Birth (city & state)
Intern ___________ ___________
Civilian ___________ ___________
Civilian Position Title
___________________________________________________________
Dates Applied (MM/YY)
Date 1
Dates Applied (MM/YY)
Date 2
M
MARICOPA COUNTY SHERIFF’S OFFICE
PRE-EMPLOYMENT SERVICES
2627 S0UTH 35
TH
AVENUE
PHOENIX, AZ 85009
AUTHORIZATION FOR RELEASE OF INFORMATION
I, _______________________________________, DO HERBY AUTHORIZE and releas
e from any and all liability, any and all
individuals, partnerships, corporations, civilian and government agencies, military agencies, law enforcement
agencies, private, City, County, State and Federal entities including the MARICOPA COUNTY SHERIFF’S OFFICE to
release, furnish and exchange any and all available information, including medical records, regarding me in order
that my suitability for law enforcement work and/or employment with Maricopa County may be determined. This
includes, but is not limited to my character, integrity and reputation.
________________________________________________________ /_______________________________
Signed Date
Date of birth
Last four digits of Social Security number
________________________________________
Home phone number
________________________________________
Cell phone number
State of Arizona
County of ______________________________)
On this day of , 20 , before me personally appeared ,
whose identity was proved to me on the basis of satisfactory evidence to be the person whose name is
subscribed to this document, and who acknowledged that he/she signed the above/attached document.
(SEAL)
Notary Public
PUBLIC DISCLOSURE OF INFORMATION:
Your Social Security number is requested for identification and record keeping purposes. Disclosure of your Social
Security number is for the purpose of conducting a thorough background investigation. The information included on this
form may constitute a public record of matter requiring disclosure under Arizona’s Public Records Law, A.R.S. 39-121 et
seq.
HANDWRITTEN FORMS NOT ACCEPTED.
FORM MUST BE FILLED OUT ONLINE THEN PRINTED.
The Maricopa County Sheriff’s Office is committed to providing the finest service possible to the citizens of this County. It is essential that
all employees exhibit the highest degree of honesty and integrity as representatives of this Office to our community.
You are about to begin our Pre-Employment processing. The Pre-Employment process is designed to obtain and evaluate your complete
personal and employment history. Prior to the start of your initial interview, it is essential that you look over your background questionnaire
to ensure it is complete and accurate. Also, take time during the Orientation process to ask any questions for which you may need
clarification. Please be advised that any information that is intentionally omitted or minimized shall result in the immediate termination of
your Pre-Employment process.
Initial:__________
1. Read each question carefully before answering it.
2. Answer each question completely and accurately.
3. If you require additional space, use the continuation sheet provided.
4. If a question does not apply to you, writeDNA” in the space provided.
Sign the Authorization for Release of Information and have it notarized.
5. When completed, please print this packet. No handwritten forms accepted.
6. Return the printed packet and all of the required documents to Pre-Employment
Services so you can be scheduled for a background interview.
Return all completed documents to:
MARICOPA COUNTY SHERIFF’S OFFICE
PRE-EMPLOYMENT SERVICES
2627 S. 35
TH
AVENUE
PHOENIX, ARIZONA
REMEMBER THAT ANY OMISSION, DECEPTION, OR FAILURE TO FOLLOW THE
INSTRUCTIONS GIVEN IN FILLING OUT YOUR PACKET COULD DELAY OR
DISQUALIFY YOU FROM FURTHER CONSIDERATION.
Maricopa County Sheriff's Office
Background Questionnaire
FOLLOW DIRECTIONS CAREFULLY
_____________________________
LAST Name
_______________________________
FIRST Name
_____________________________________
MIDDLE Name
HANDWRITTEN FORMS WILL NOT BE ACCEPTED.
FORM MUST BE FILLED OUT ONLINE AND THEN PRINTED.
Maricopa County Sheriff’s Office
Background Questionnaire
Name: ________________________________________________________________________
Last Name First Name Middle Name
Be sure to read all directions thoroughly and complete all questions with the required information. If a
question does not apply to you, writeDNA in the space. INITIAL in the bottom right corner.
Position Applying For:
Reserve Deputy
Deputy Trainee
This questionnaire will be used to determine your suitability for employment with Maricopa County, or a
commission with the Maricopa County Sheriff’s Office. It may also be used when necessary to comply with state and local
statutes. An extensive background investigation will be conducted into your personal history.
Applicants applying for compensated positions, Reserve Deputy, and select volunteer positions will be required to
undergo a polygraph examination to confirm the information in this questionnaire, as well as other background
information obtained during your process.
A psychological assessment is also required for Deputy Trainee, Reserve Deputy, Detention Officer, and select civilian
positions.
I understand that I will not receive, and I am not entitled to information collected during the course of my
application process, and I further understand that the information collected will be used in the evaluation process for
employment with Maricopa County. Further, no documents submitted by me will be returned and no copies of any
reports or documents utilized for or during my application for employment or a commission will be furnished or given
to me. If I am not selected for employment, I WILL NOT BE ADVISED OF THE REASONS FOR NON-SELECTION.
Initial here:
Please ensure that all future questions and/or concerns during your process are directed solely to your assigned
investigator. In the event the investigator is unavailable, the supervisor of your investigator will be able to assist you.
This line of communication is essential to expedite your application and ensure a complete and accurate
investigation. _____________________ Initials
APPROPRIATE BUSINESS ATTIRE is required for all steps of your processing. Please dress
appropriately for all appearances, interviews, polygraph examinations, psychological evaluations and
employee orientations. Failure to comply may result in your removal from the hiring process.
REQUIRED DOCUMENTS
You are required to provide the following documents at the time you turn in this packet and prior to being
scheduled for an interview:
Government issued Birth Certificate, Passport, Naturalization Certificate or Resident Alien card
Social Security Card (Front and Back), must be legible and contain discernable security features
Arizona Driver’s License (Front and Back) Note: If you are an out of state applicant, you must obtain an
Arizona Driver’s License prior to employment if a license is required for the position.
High School Transcripts or Diploma, or GED
DD214: Prior to 1979, Member 1 copy; after 1979, Member 4 copy (For prior U.S. Military service)
Marriage License (Government issued)
Police Reports
Court Documents (Civil and/or Criminal)
Other degrees, licenses or certifications required for the position, or other information requested from your
investigator.
You must provide both an original or certified copy of each required document and a photocopy for your file.
Please photocopy the front and back of any two-sided documents. If you are unable to obtain documents prior
to returning this packet, note what you have done to obtain the missing documentation on Continuation page of
this packet. You will need to obtain the required
documents
before being continued in processing.
Detention Officer
Intern
Sheriff's Posse
Deputy Lateral
Civilian (Enter Position Title) ____________________________________________________________________
PERSONAL DATA
First Name
___________
Middle Name
_________________________
_________________________________________________________
Current Address
(Street & Number)
City
State
Zip
Code
Length of time at current address: _______/_______ (Years/Months)
________________________________________________________
Last Name
_____________________________________
___________________________________
________________________________________________________________________________________________________________________________
Address (Street & Number) City
State
Zip Code
From:Month/Year-To:Month/Year
_________________________________________________________________________________________________________________________________
Address (Street & Number) City State Zip Code From:Month/Year-To:Month/Year
________________________________________________________________________________________________________________________________
Address (Street & Number) City
State
Zip Code
From:Month/Year-To:Month/Year
________________________________________________________________________________________________________________________________
Address (Street & Number) City
State
Zip Code
From:Month/Year-To:Month/Year
Status (Check One):
Single Married Separated Divorced Widowed
Co-Habitate
Date married:________________________________________If married, list spouse's maiden name:_______________________________
Child’s name
Date of birth Address
Child’s name
Date of birth Address
________________________________________________ _________________________ ___________________________________________________
Spouse's or Co-Habitant's full name Date of birth-mm/dd/ Spouse or Co-Habitant's occupation
________________________________________________ _________________________ ___________________________________________________
________________________________________________ _________________________ ___________________________________________________
Citizenship Status: Unites States Citizen ________ Permanent Resident Alien ________ Other (specify) _____________
_______________________________
_____________________________
________________________________
Home telephone number
Work telephone number
Cellular telephone number
Email address: ______________________________@___________________ Social Security Number: _______________________________
Height-Ft/Inch
Weight
Hair Color Eye Color Date of Birth Place of Birth (city/state)
_______________________________________________________________________________________________________________________________
List all previous residences in the last ten (10) years: (List complete addresses, City, State and Zip Codes)
MARITAL STATUS
__________________________
List all places of employment and dates you were employed during your lifetime, beginning with
the present or most recent employer and going backwards. List all employers in
proper sequence. OMIT NONE! If you require additional space, please print additional copies of pages.
Have you been terminated, or left employment in lieu
of termination within the past 3 years? Yes No
Have you ever been accused of misconduct by an employer? Examples: theft, harassment, misconduct, etc.
Yes No
If you answered to any of the questions above, please provide Month/Yr, Employer, and a detailed explanation in
the space below:
____________________________________________________________________________________________________________________________________
_______________________________________________________________
_______________________________________
NAME OF EMPLOYER
_____________________________________________________________________________________________________________
Complete street address
City
State
Zip Code
Phone
__________________________________________________________________________________________________________
Job title Describe your duties
______________________________________________________________________________________________________
Describe reason for leaving (resigned, terminated, relocated, went back to school, etc.)
______________________________________________________________________________________________________
NAME OF EMPLOYER
__________________________________________________________________________________________________________
Complete street address City State Zip Code Phone
_
_________________________________________________________________________________________________________
Job title - Describe your duties
___________________________________________________________________________________________________________
Describe reason for leaving (resigned, terminated, relocated, went back to school, etc.)
____________________________________________________________________________________________________________
NAME OF EMPLOYER
____________________________________________________________________________________________________________
Complete street address
City State
Zip Code Phone
__________________________________________________________________________________________________________
Job title Describe your duties
___________________________________________________________________________________________________________
Describe reason for leaving (resigned, terminated, relocated, went back to school, etc.)
Month and Year:
From: _____________
To: Current
Salary:
Start:____________
End: _____________
Month and Year:
__
From: ______________
__
To:
_____________
Salary:
Start: _____________
End: _____________
Month and Year:
From: _____________
To: ______________
Salary:
Start: ____________
End: _____________
EMPLOYMENT HISTORY
Month and Year:
Month and Year:
From:______________
To: ______________
Salary:
Start: ______________
End: _____________
________________________________________________________________________________________________________
Complete street address
City
State Zip Code Phone
_________________________________________________________________________________________________________________________________________________
Job title - Describe your duties
________________________________________________________________________________________________________________________________________________
Describe reason for leaving (resigned, terminated, relocated, went back to school, etc.)
________________________________________________________________________________________________________
NAME OF EMPLOYER
_______________________________________________________________________________________________________
Complete street address City State Zip Code Phone
_______________________________________________________________________________________________________
Job Title - Describe your duties
________________________________________________________________________________________________________
Describe reason for leaving (resigned, terminated, relocated, went back to school, etc.)
________________________________________________________________________________________________________
NAME OF EMPLOYER
_______________________________________________________________________________________________________
Complete street address City State Zip Code Phone
_______________________________________________________________________________________________________
Job title - Describe your duties
_______________________________________________________________________________________________________
Describe reason for leaving (resigned, terminated, relocated, went back to school, etc.)
From: ______________
To: ______________
Salary:
Start:
_____________
End: ______________
Month and Year:
From: ______________
To: ______________
Salary:
Start: _____________
End: _____________
Month and Year:
From: _____________
To: ______________
Salary:
Start: _____________
End: _____________
________________________________________________________________________________________________________________________________________________
NAME OF EMPLOYER
________________________________________________________________________________________________________
Complete street address
City
State Zip Code Phone
________________________________________________________________________________________________________________________________________________
Job Title - Describe your duties
Describe reason for leaving (resigned, terminated, relocated, went back to school, etc.)
NAME OF EMPLOYER
Salary
:
Start: _____________
End: _____________
LAW ENFORCEMENT HISTORY
Have you ever been terminated while working for a law enforcement agency? Yes ____ No ____
Have you ever received discipline while working for a law enforcement agency? Yes ____ No ____
If you answered yes to any of the questions above, please provide Month/Year, Employer and a detailed
explanation in the space below:
_____________________________________________________________________________________________________________________________________
_____________________________________________________________________________________________________________________________________
_______________________________________________________________________________________________________
NAME OF EMPLOYER
_______________________________________________________________________________________________________
Complete street address City State Zip Code Phone
_______________________________________________________________________________________________________
Job title Describe your duties
_______________________________________________________________________________________________________
Describe reason for leaving (resigned, terminated, relocated, went back to school, etc.)
_______________________________________________________________________________________________________
NAME OF EMPLOYER
_________________________________________________________________________________________________________
Complete street address City State Zip Code Phone
____________________________________________________________________________________________________________
Job title Describe your duties
____________________________________________________________________________________________________
Describe reason for leaving (resigned, terminated, relocated, went back to school, etc.)
_______________________________________________________________________________________________________
NAME OF EMPLOYER
____________________________________________________________________________________________________
________
Complete street address City State Zip Code Phone
________________________________________________________________________________________________________
Job title Describe your duties
_____________________________________________________________________________________________________
Describe reason for leaving (resigned, terminated, relocated, went back to school, etc.)
Month and Year:
From: ______________
To: ______________
Salary:
Start: _____________
End: _____________
Month and Year:
From: ______________
To: ______________
Salary:
Start: _____________
End: _____________
From: ______________
To: ______________
Rev 3/18
Month and Year:
List the names of any acquaintances you have who are employed by the Maricopa County Sheriff’s Office:
___________________________________________________________________________________________________________________________________
Have you ever applied to, been employed by, or volunteered for the Maricopa County Sheriff’s Office in
any capacity?
Yes _______ No _______ If Yes, date and position: __________________________________________________________________________
Have you ever applied for any position or had any involvement or association with another law
enforcement agency, including the Department of Corrections and similar agencies?
If Yes, explain (use Continuation area on last page if necessary):
Date Graduated
School Name
City, State
Type of diploma/degree earned
__________________
_____________________________________ _____________________________________ _______________________________
__________________
_____________________________________ _____________________________________ _______________________________
__________________
_____________________________________ _____________________________________ _______________________________
__________________
_____________________________________ _____________________________________ ______________________________
PROFESSIONAL ORGANIZATIONS List any organizations you are affiliated with.
___________________________________________________________________________________________________________________________________
MILITARY HISTORY
Mandatory question for male applicants: If you are/were required to do so, are/were you registered with
the Selective Service?
Yes _______ No _______
Registration# ______________________ If No, explain: _________________________________________________________________________
You may obtain information regarding your Selective Service registration at: www.sss.gov
Yes No
____________________________________________________________________________________________________________________________________
Month/Year Agency name and state Position Status of application
____________________________________________________________________________________________________________________________________
Month/Year Agency name and state Position Status of application
Have you ever received any law enforcement training? Yes No If Yes, explain below:
_____________________________________________________________________________________________________________________________________
When Where
Have you ever been certified as police officer?
Type of Training
Yes________ No_________
____________________________________________________________________________________________________________________________________
When Where Type of certification Current status of certification
EDUCATION AND TRAINING
List all schools (high schools, colleges, universities and graduate schools) you have attended. List GED if
applicable:
Have you ever served or are currently serving in the Military? Yes ______ No ______
Dates of service: From ____________________________ to ___________________________ Branch:__________________________________
MOS ____________________________Discharge date:_________________________Type of discharge _________________________________
Rank upon discharge:__________________________________________
List any disciplinary action that you have ever received in the military (include date, type, reason and resolution):
____________________
________________________________________________
DRIVING HISTORY
_______________________________________________
Current driver’s license number & state
Expiration date
Previous driver’s license state (s)
Have you ever had your license suspended? Yes _______ No _______ If yes, please explain: ____________________________
____________________________________________________________________________________________________________________________________
Date of suspension: Month ________ / Year ________ Date reinstated: Month ________ / Year _______
Date of suspension: Month ________ / Year ________ Date reinstated: Month ________ / Year _______
List below all traffic citations you have received in the last 10 years (sworn/reserve please list
all citations received in your lifetime), in this country or any other country.
Date
(Month/Year)
Location
(City, State)
Issuing Agency
(DPS, Phoenix PD,
MCSO, etc.)
Charge
(Speeding,
Failure to yield,
etc.)
Disposition
(Paid fine,
driving school,
etc.)
Accident
related
Y / N
If you listed anything in the above chart, please provide a detailed explanation in the space provided below.
____________________________________________________________________________________________________________________________________
POLICE CONTACT / OFFENSE HISTORY
Please list in the following chart (Do not use criminal codes) ANY contact you have had with a civil or military
official of any kind, including as a witness, victim, suspect, responder, etc. Also list if you have EVER been arrested,
convicted, charged, questioned or detained (including cited and released) for ANY offense, violation of ANY statute
or ordinance by any civil or military authority. (Please include any convictions or adjudications as a juvenile. If a
charge was dismissed, explain what had to be satisfied prior to the dismissal (attended classes, probation,
interlock device, etc.)pr
No
No
No
No
No
No
No
Date
(Month/Year)
Location
(City/State)
Issuing Agency
(DPS, Phoenix
PD, MCSO, etc.)
Original Charge
(Aggravated assault,
Burglary, Grand
Theft, etc.)
Reduced to
(Assault, Theft,
Theft of means,
etc.)
Disposition/
Court Action
(Guilty, not
guilty, paid
fine)
If you listed anything in the above chart, please provide a detailed explanation in the space provided below.
Complete all questions; if you answer yes to any question provide a detailed explanation in the space provided (to include
month/year of last use and type)
DRUG USE
Have you ever used a prescription drug that was not prescribed to you? (Pain killers, muscle relaxers, antibiotics,
sleep aids, etc.) Yes _____ No _____
If yes, please explain: ___________________________________________________________________________________________________________
Type: _______________ Date of last use: _______ / _______ Type: _______________ Date of last use: _______ / ________
Have you ever used a prescription drug for other than the prescribed purpose? Yes _____ No _____
If yes, please explain: ___________________________________________________________________________________________________________
Type: _______________ Date of last use: _______ / _______ Type: _______________ Date of last use: _______ / ________
Have you ever GIVEN or SOLD prescription drugs, marijuana or any other illegal narcotics or dangerous drugs?
Yes
No
If yes, please explain what drug, the quantity given or sold, when, including month and year and the amount you
profited, if any:
INSTRUCTIONS FOR DRUG USE QUESTIONS
Marijuana
0 1 2-5 6-10 11-20 21-50 51+
TOTAL times tried Age 21 and older
0 1 2-5 6-10 11-20 21-50 51+
TOTAL times tried before age 21.
MARIJUANA
In the marijuana chart below, indicate your marijuana usage by checking the boxes that most accurately
reflect your history with marijuana to the best of your knowledge. Indicate the date of last use and your
age at the time of last use.
A use is defined as an "occurrence."
For example,if you have never tried marijuana, this would count as (O) uses. If you used marijuana on
one occasion, but took multiple puffs, it would count as one (1) use. However, if you left the area where
you were using marijuana, and later returned and used more marijuana, that counts as two (2) uses.
NOTE: The chart is broken down into two sections;
1. one being your use BEFORE the age of 21,
2. the other being your use AFTER the age of 21)
In the chart below, please indicate your marijuana usage by checking the boxes that most accurately
reflect your history. Do not guess!
Date of last use (Month/Year): _________________________ Age at last use: __________
OTHER DRUGS, NOT INCLUDING MARIJUANA
In the listed charts, indicate your drug usage by checking the boxes that most accurately reflect your history with
each drug. In the first chart, you will add all usages listed in the charts on the page (EXCLUDING marijuana) and
indicate the month/year of the last use and your age at the last use.
NOTE: The charts are broken down into two sections;
1. one being your use BEFORE the age of 21
2. the other being your use AFTER the age of 21.
If you have never tried any of the drugs in any of the charts this would count as (O) uses and you are required
to check the appropriate boxes in each chart.
How to determine usage of Other Drugs: (not including marijuana):
Each occurrence counts as one (1) use.
For example, if you took a complete cycle of steroids, that is not one (1) use, it is the total number of times you put
the substance in your body (pill or shot form).
Similarly, if you were around cocaine, and throughout the course of time ingested two “lines,” that counts for two
(2)uses, even if you ingested them one right after the other. So, if you used marijuana and cocaine during the
same“occurrence”, this would count as one (1) “use” of marijuana and one (1) “use” of cocaine.
Page 10 of 12
In the charts below, please indicate your usage for all other drugs (excluding marijuana) by checking the boxes
that most accurately reflect your history with that drug. Do not guess!
OTHER DRUGS
Date of last use (Month/Year): ________________________________ Age at last use: __________
(A) Cocaine
and/or Crack
TOTAL times tried before Age 21.
0
1
2-5
6-10
11-20
21-50
51+
(B) Hallucinog
ens
LSD, PCP, Acid,
Mushrooms,
Mescaline,
Peyote
TOTAL times tried before Age 21.
0
1
2-5
6-10
11-20
21-50
51+
(C) Dangerous
Drugs
Opium,
Morphine,
Ecstasy,
Heroin, GHB
TOTAL times tried before Age 21.
0
1
2-5
6-10
11-20
21-50
51+
(D) Ampheta-
mines
Crystal Meth,
Speed, Ice,
Glass
TOTAL times tried before Age 21.
0 1 2-5 6-10 11-20 21-50 51+
(E) Steroids
Pills and/or
Injections
TOTAL times tried before Age 21.
0 1 2-5 6-10 11-20 21-50 51+
(F) Inhalants
Spray Paint,
Glue, Gasoline,
Lighter Fluid
TOTAL times tried before Age 21.
0
1
2-5
6-10
11-20
21-50
51+
(G) Designer
Drugs
Incense/Spice,
Bath Salts, K2,
Salvia
TOTAL times tried before Age 21.
0
1
2-5
6-10
11-20
21-50
51+
(H) Any other
drug not liste
d in tables A-
G:
TOTAL times tried before Age 21.
0
1
2-5
6-10
11-20
21-50
51+
TOTAL times tried Age 21 and older
0
1
2-5
6-10
11-20
21-50
51+
TOTAL times tried Age 21 and older
0
1
2-5
6-10
11-20
21-50
51+
TOTAL times tried Age 21 and older
0
1
2-5
6-10
11-20
21-50
51+
TOTAL times tried Age 21 and older
0
1
2-5
6-10
11-20
21-50
51+
TOTAL times tried Age 21 and older
0
1
2-5
6-10
11-20
21-50
51+
TOTAL times tried Age 21 and older
0
1
2-5
6-10
11-20
21-50
51+
TOTAL times tried Age 21 and older
0
1
2-5
6-10
11-20
21-50
51+
TOTAL times tried Age 21 and older
0
1
2-5
6-10
11-20
21-50
51+
TOTAL of all drugs tried Age 21 and
older
0 1 2-5 6-10
11-20
21- 50
51+
TOTALS OF
ALL OTHER
DRUGS
(Add all
results of
tables A-H
only)
TOTAL of all drugs tried before Age 21.
0
1
2-5
6-10
11-20
21-50
51+
Page 11 of 12
CONTINUATION
This space is provided to allow you the opportunity to offer additional information and/or clarification for
questions asked on previous pages. You may make a photo copy of this page if needed.
Section Title
Additional Information/Explanation
Page 12 of 12
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