CONDUCT AND LAW

BAKERSFIELD PO LIC E DEPARTMENT

PRE-INVESTIGATION BACKGROUND

QUESTIONNAIRE

As an applicant for a position with this agency, you are required to complete this

background questionnaire. This questionnaire supplements your Personal History

Statement (PHS) and will be treated with the same confidentiality as your PHS.

Pursuant to the Americans with Disabilities Act (ADA), you are not expected or

required to furnish any information in this questionnaire which is of a medical nature.

For example, do not report any work absences which were for illnesses or worker

compensation injuries. Do not discuss or report any disabilities you may have. Do

not discuss or report any information concerning illnesses you may have. This

information is strictly medical in nature and, as this questionnaire is part of the

pre-offer background suitability investigation, is not subject to disclosure during this

portion of the process.

Please read and answer all of the following questions. Answer all questions

truthfully, as your honesty will be evaluated. A "Yes" answer to any question on this

questionnaire will not necessarily disqualify you from consideration for this position;

however, any omissions, falsifications, misstatements, untruthful responses,

discrepancies or failure to provide explanations for “Yes” answers will be cause for

disqualification from the hiring/background process. Public safety agency employees

must demonstrate integrity and credibility as a witness in a court of law. Your

responses to these questions will be evaluated and considered in relationship to your

entire background.

If you answer "Yes" to any of the questions, you must provide an explanation

and date of the incident. Use the blank sheets at the end of this questionnaire

and make sure to include the question number.

If you need additional space, make copies of a blank sheet at the end of the

questionnaire before continuing.

• Throughout this questionnaire, the word “ever” refers to your lifetime.

• Do not discuss this questionnaire with other applicants at any time.

• You will be given the opportunity to discuss your answers with the background

investigator.

• You will not be allowed to have a copy of this document.

• This document, your Personal History Statement, and all portions of the

Background Investigation are the property of the Bakersfield Police

Department.

PRINTED NAME: __________________________________________

APPLICANT SIGNATURE

:______________________________ DATE: _____________

2019-03-29

Page 1 of 11

C O NDUCT AND LAW

Ye s No

1. Either as an adult or a juvenile, have you ever been arrested or charged with a criminal

act even if the charges were dismissed, dropped, reduced, or expunged?

2. Either as an adult or a juvenile, have you ever been detained for a criminal

investigation, named as a suspect in a police report, held on suspicion, or questioned

by the police, even as a victim or witness?

3. Have you ever had a warrant issued for your arrest, or have you ever failed to appear

in court on a criminal matter?

4. Were you ever required to appear before a juvenile court for an act that would have

been a crime if committed by an adult?

5. Have you ever received a misdemeanor citation in lieu of going to jail?

6. Have you ever been placed on court probation?

7. Are you currently on probation?

8. Have you ever violated a condition of probation?

9. Have you ever carried a concealed weapon?

10. Have you ever applied for a permit to carry a concealed weapon?

Note: While answering questions 11 through 42, the following applies: Have you ever been involved in,

been associated with anyone involved in, or committed any of the following acts, as an adult or a

juvenile (including incidents where the records were sealed or expunged by a court)?

11. Forgery

12. Arson

13. Theft of a vehicle or vehicle parts

14. Theft from any employer regardless of the value

15. Theft of any kind including shoplifting

16. Rape

17. Robbery

18. Burglary

19. Murder, homicide or attempted murder

20. Displaying a weapon in a threatening manner to another person (Brandishing)

21. Resisting arrest

22. Illegal gambling

23. Impersonation of a peace officer

24. Prostitution

25. Vandalism

26. Used falsified or altered identification or used identification of another person

27. Made annoying or obscene phone calls

28. Blackmail or extortion

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C ONDUC T AND LAW (c o ntinue d)

Ye s No

29. Kidnapping

30. Discharging a firearm at a person or at a building

31. Exposed your private parts in a manner intended to offend anyone

32. Had a criminal record sealed

33. Been reported as a missing person or runaway

34. Looked into windows invading someone’s privacy

35. Covered up a crime for someone

36. Had a restraining order filed against you

37. Violated a restraining order

38. Filed a false police report

39. Assisted in the escape of a prisoner from police custody

40. Offered a bribe to a public officer

41. Committed perjury

42. Committed welfare fraud

43. As an adult, have you ever had sex with a person under the age of 18?

44. Have you ever been arrested or taken to jail while outside the United States?

45. Have you ever been involved in a physical fight, confrontation or violent act?

46. Have you ever been a member or an associate of a hate group?

47. Have you ever tortured, maimed, abused or killed an animal for any reason

other than

when engaged in lawful hunting activity?

48. Are you currently being investigated by any law enforcement agency for any

suspected illegal activity?

49. Have you ever been a member of, or associated with, a street, prison, or

neighborhood gang?

50. Have you ever lived with, or associated with, anyone who was involved criminal

activity, including drug use?

51. Have you ever accessed web sites on the internet to view child pornography or

possessed material related to child pornography?

52. Have you ever belonged to an organization, ever subscribed to, regularly read or

distributed magazines, newspapers, newsletters or other literature, ever accessed

internet web sites, that advocated beliefs about inferiority, deviance, or need for the

elimination of groups on the basis of race, religion or sexual orientation?

53. Have you ever harassed someone on the basis of their sexual orientation, gender,

race or ethnicity, or immigrant status (i.e. taunting, name-calling, threats, intentional

humiliation, etc.)?

54. Have you ever committed any hate crimes on the basis of race, religion, immigrant

status, gender, HIV/AIDS infection or sexual orientation (i.e. destruction of property

motivated by bias or prejudice, written derogatory epithets during a vandalism or

burglary, written/sent/verbalized derogatory epithets to another person or group,

physical assault on the basis of personal characteristics, or withheld services,

provided inferior service, evaluated employees/supervisors unfairly, etc.)?

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CO NDUCT AND LAW (c o ntinue d)

Ye s No

55. Have you ever stalked another person (i.e. willfully, maliciously and repeatedly

followed and harassed another person and seriously alarmed, annoyed, tormented,

or terrorized that person, made unwanted repetitive phone calls, email, fax, letters,

notes, watched someone without their knowledge, intentionally created fear in

another person through various acts, violated a restraining order, etc.)?

56. Have you ever assaulted another person in an intimate relationship or during the

relationship’s termination?

57. Have you ever committed any acts of physical violence (i.e. slapping, hitting, beating,

arm-twisting, spitting, etc.) within an intimate relationship, including both casual and

long-term relationships?

58. Have you ever mentally or emotionally abused a child (i.e. frequently called them

hurtful names, threatened them, humiliated them, insulted them, intentionally tried to

hurt their feelings or make them feel bad, etc.)?

59. Are you now, or have you ever been a member of any organized association, group,

or movement, who advocated the overthrow of our constitutional form of government

by any means other than democratic procedures provide by our form of government?

60. Are you now, or have you ever been a member of any organized association, group,

or movement, who advocated/advocates acts of force or violence to deny other

persons their Constitutional Rights by unconstitutional means?

61. Are you now, or have you ever been associated with any individuals, including

relatives, who you know, or have reason to believe are, or have been, members of

any types of organizations identified above?

62. Have you ever had a sexual contact with a child (i.e. fondling, taking pornographic

pictures, masturbating in a child’s presence, oral sex, sexual intercourse, etc.)?

63. Have you ever neglected the care of a child or elderly person who was your

responsibility (i.e. did not feed, clean, clothe, or take care of medical needs, etc.)?

64. Have you ever participated in an unlawful demonstration?

65. Have you ever engaged in civil disobedience?

66. Have you ever been the victim of assault behavior within an intimate relationship?

67. Have you ever abused a child?

MILITARY

Ye s No

68. Did you comply with the Selective Service Registration as required by law? (This

question only applies to male candidates)

Note: Applicants with military experience answer the following questions; All others skip this section.

69. Were you honorably discharged from the military?

70. Have you ever been AWOL or UA (unauthorized absence)?

71. Were you ever court-martialed?

72. Were you ever in military confinement?

73. Have you ever been reduced in pay grade or been the subject of judicial punishment

or non-judicial disciplinary action while in the military?

74. Were you ever detained, arrested, jailed or held by police or security forces in another

country for anything other than minor traffic offenses?

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MILITARY (c o ntinue d)

Ye s No

75. Were you ever denied a security clearance or had a clearance revoked, suspended or

downgraded?

76. Were you ever investigated for any criminal activity while in the military, or received

verbal or undocumented discipline?

LAW ENFO RCEMENT APPLIC ATIONS AND EXPERIENC E

Ye s No

77. Have you ever been disqualified, non-selected, or advised to withdraw from any law

enforcement agency application process?

78. Have you ever taken a polygraph examination?

Note: Applicants who are now, or have previously been, peace officers, reserve peaces or military police

officers should answer the following questions; all others skip this section.

79. As a peace officer, did you ever accept a gratuity?

80. As a peace officer, did you ever accept anything for overlooking a violation?

81. As a peace officer, did you ever make a false official report?

82. As a peace officer, have you ever withheld any evidence seized in the course of your

official duties?

83. As a peace officer, did you ever observe another peace officer commit any of the

above acts?

84. As a peace officer, were you ever the subject of an internal investigation by your

department?

FINANC ES

Ye s No

85. Have you been late on any payments in the last 12 months?

86. Have you ever provided false information on a credit or loan application?

87. Have you ever had any property, including a vehicle, repossessed?

88. Have any of your debts ever been turned over to a collection agency?

89. Have you ever filed or been granted bankruptcy?

90. Have you ever been delinquent on any tax payments?

91. Have you ever had your wages attached or garnished?

92. Have you been refused credit in the last year?

93. Have you ever been the subject of a property lien?

VEHIC LE O PERATIO N

Ye s No

94. Do you currently have vehicle insurance?

95. Have you ever driven a vehicle without insurance?

96. Have you ever been refused vehicle insurance for any reason?

97. Have you ever had a traffic warrant issued for your arrest?

98. Have you ever indicated a residential address on your vehicle insurance policy that

was not your actual residence at the time?

99. As a driver, have you ever been involved in an accident where you left the scene

without identifying yourself (hit and run)?

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VEHICLE O PERATIO N (c o ntinue d)

Ye s No

100. Have you ever been refused a driver license in any state?

101. Have you ever failed to appear for a traffic citation or parking citation?

102. Has your driver license ever been suspended, revoked, or placed on negligent

operations probation by any state?

103. Have you ever applied for, or obtained, a driver license or state identification card

under a fictitious name?

104. How many moving and non-moving traffic citations have you received, and how many at-fault

traffic collisions have you been involved in?

Citations in the last five years:_____ At-fault traffic collisions in the last five years:_____

RESIDENCE

Ye s No

105. Have you ever been evicted or asked to leave a residence?

106. Have you ever left a residence without paying your rent?

107. Have you ever had problems or difficulties with any of your roommates or neighbors?

108. Have the police or any law enforcement agency ever been to your home or any of

your residences?

109. Are you currently living or associating with anyone who has been convicted of a

felony or who is on parole?

EMPLO YMENT

Ye s No

110. Have you ever been employed under another name?

111. Have you ever participated in sexual harassment or discrimination the workplace?

112. Have you ever been so angry at work that you became involved in a loud argument?

113. Did you ever have conflicts or difficulties with a supervisor or coworker?

114. Has anyone ever complained about you or your work performance (verbal or written)?

115. Have you ever quit a job without giving proper notice?

116. Have you ever been terminated (fired) or asked to resign in lieu of termination from a

job or position?

117. Have you ever had any extended work absences for any reason other than medical

or earned vacation (i.e. leave of absence, suspensions, layoffs, etc.)?

118. Have you ever been investigated by your employer or supervisor for improper

conduct, illegal activities, sexual harassment, or equal employment violations?

119. Will any employer or supervisor (past or present) give you an unfavorable

recommendation?

120. Has any supervisor (including military) ever disciplined you or warned you either

verbally or in writing (i.e. excessive tardiness, excessive absences, poor work

performance, excessive personal phone use, unprofessional behavior or conduct,

arguing, no call/no-show, etc)?

ALC O HO L C O NSUMPTIO N

Ye s No

121. Do you drink alcohol? (Answer Yes / No – no explanation required)

122. Has excessive drinking of an alcoholic beverage ever caused you to miss work or

perform poorly at work?

123. What kind of alcohol do you normally drink? ________________________________

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ALC O HO L C O NSUMPTIO N (c o ntinue d)

124. Approximately how much alcohol (drinks) do you drink in one month? ____________

125. Approximately how many times in your life have you been drunk? Indicate the number of times and

the last time:

Number of times:_____________________ Last time:______________________

126. Approximately how many times in your life have you driven a vehicle while you were under the

influence of alcohol? For the purpose of this question, consider under the influence as when you felt

the effects of the alcohol, or when you may have been arrested if stopped by the police.

Number of times:_____________________ Last time:______________________

List each incident below, starting with the most recent:

Date of the incident

Month/Year

How much did you drink? How long did you drink? How far did you drive?

Note: While answering questions 124 through 150, the following applies:

Have you ever illegally used, tasted, ingested, inhaled, injected, sniffed, smoked,

swallowed, had any experimentation whatsoever, or pretended to use any of the

following drugs, regardless of the amount?

NARC O TIC AND SUBSTANCE USA G E

Ye s No

127. Marijuana

128. Hashish

129. Cocaine (coke, snow, nose, etc.)

130. Crack cocaine (crack, rock, free base, rock cocaine, etc.)

131. Ecstasy

132. Methamphetamine (meth, crank, speed, etc.)

133. Amphetamines (uppers)

134. Barbiturates (downers)

135. Magic mushrooms (Psilocybin)

136. Inhalants including aerosol sprays, cleaning fluids, glue, solvents, Nitrous Oxide, etc.

137. Steroids

138. Heroin

139. Opium

140. Morphine

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NARC O TIC AND SUBSTANCE USA G E (c o ntinue d)

Ye s No

141. Amyl Nitrite (poppers)

143. LSD

143. Phencyclidine (PCP)

144. Designer Drugs (synthetic heroin, china white, ice, etc.), or any other illegal drug /

substance not previously listed?

145. Spice, Salvia or Bath Salts

146. Have you ever used a prescription drug not prescribed for you?

147. Has anyone ever used illegal drugs or narcotics in your presence, home or vehicle?

148. Have you ever purchased any illegal drugs or narcotics?

149. Have you ever held, kept, or hidden drugs from someone else?

150. Have you ever attended a party or gathering, where drugs were being used?

151. Have you ever driven a vehicle while under the influence of drugs?

152. Have you ever sold, provided, packaged or given illegal drugs or narcotics to anyone?

153. Have you ever remained in a place where drugs, narcotics or other illegal substances

were used?

154. Have you ever grown or assisted in growing marijuana, or manufactured or assisted

in producing or manufacturing drugs?

ADDITIONAL BAC KG RO UND Q UESTIO NS

Ye s No

155. Have you ever embezzled any money or valuables which were entrusted to you?

156. Have you ever committed an act of incest?

157. Are any members of your family associated with a street gang?

158. Have you ever gambled while behind on personal debts?

159. Have you ever attempted suicide or intentionally harmed yourself?

160. Have you ever been involved in a hazing incident?

161. Do you possess or own any firearms? (List Make, Model & Serial Numbers)

162. Have you ever forced another person, including your spouse, ex-spouse, or domestic

partner, to have sexual intercourse or to engage in any other sexual act (oral

copulation, sodomy, etc)?

163. Have you ever indicated to someone else that you attempted suicide in order to get

sympathy or attention?

164. Have you ever purchased or participated in the construction of any explosive device

of any kind?

165. Has anyone advised or prepared you on how to answer these background questions?

6. Do you have any tattoos, brands and body piercings? If so, describe each including

the location on your body.

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C ERTIFIC ATIO N

I understand that any untruthful answer or response on this questionnaire will result

in my disqualification from the hiring process or termination from employment, if a

position of employment was offered.

I certify that I answered all questions truthfully. I understand that any changes

involving my background responses such as, but not limited to: receiving any traffic

citations, involvement in any criminal activity, arrests, being named on a crime

report, financial problems, civil or criminal lawsuits, changes in residence, illegal

drug use, employment changes such as termination, applications to other law

enforcement agencies, or background disqualification from other law enforcement

agencies, must be immediately reported to my background investigator.

Failure to do so may result in my disqualification. I have read and understand the

instructions provided.

Candidate’s signature:______________________________ Date:____________

Interviewed by:____________________________________ Date:____________

7/13

2019-03-29

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ADDITIONAL INFORMATION

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ADDITIONAL INFORMATION

2019-03-29

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