SCOTTSDALE POLICE DEPARTMENT BACKGROUND QUESTIONNAIRE

NAME:

POSITION APPLIED FOR:

Please print all responses neatly and legibly

READ AND FOLLOW THE DIRECTIONS CAREFULLY

A. Do not print the questionnaire double-sided (single-sided pages only).

B. Do not remove any of the numbered pages.

C. Personally complete this packet in your own writing. MUST BE HAND PRINTED IN BLACK INK. Provide a memo of explanation if you received assistance with filling out this packet or were unable to complete it yourself.

D. Answer each question completely and accurately.

E. If you need additional space, use supplemental pages 37 - 40. Photocopy supplemental pages if needed.

F. Include complete addresses, email addresses and phone numbers.

G. Sign all required pages of the questionnaire and have pages 41 & 42 notarized.

H. Do not bind or staple any of the documents being submitted.

I. Return the completed packet in a sealed envelope to the Scottsdale Police Department Personnel Unit by the due date:

SCOTTSDALE POLICE DEPARTMENT Personnel Unit 8401 E. Indian School Road Scottsdale, AZ 85251

NOTICE

Failure to follow instructions will delay the background process or eliminate you from further consideration. An incomplete or sloppy packet will be rejected. Packets returned to any other work unit, other than the Personnel Unit, could result in your disqualification for the position for which you applied.

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Scottsdale Police Department

TERMS AND CONDITIONS

• I understand that if I am a current City of Scottsdale employee any information acquired through the selection process that could be considered criminal or against City policies may result in disciplinary action, up to and including termination.

• I understand I will not receive, nor am I entitled to, a copy of the background investigation or knowledge of its contents.

• I understand that completing this packet does not automatically imply that I am in the background process. The packet merely allows the Police Department to determine my suitability towards moving forward with a complete background investigation.

• I understand a City of Scottsdale Police Department investigator will conduct an extensive background investigation into my personal history.

• I understand the contents of the background questionnaire and the findings of the investigation are confidential and will be used in the evaluation process for employment with the City of Scottsdale or other agencies upon receipt of a signed release.

• I understand I will be required to take a polygraph examination and psychological assessment. I may also be required to take a medical examination if required for the position applied.

• I understand no documents submitted by me will be returned and no copies of reports or documents utilized for or during the employment process will be furnished or given to me.

• I understand if I am not selected for employment, I will not be advised of the reason.

• I understand I will need to bring and show the background investigator the following documents at the time of the background interview: original birth certificate (Bureau of Vital Statistics copy), Naturalization Papers, Driver’s License or State Identification card (if applicable), Social Security card, Military Discharge DD 214 (member 4), Marriage License, Divorce and / or Name Change documents, and any other documents necessary to complete the background process. Do not send the original documents listed above with the background questionnaire; bring them with you at the time of your background interview for review by the background investigator.

• I understand the background investigator will make photocopies of these documents and return the original items to me. The background investigator will retain the photocopies of these documents.

• I understand I will need to bring original (sealed) High School and College transcripts to the background investigator at the time of the background interview.

• I understand I must complete this packet in my own handwriting and will provide a memo of explanation if I receive assistance with filling out this packet or am unable to complete it myself.

• I understand I must provide COMPLETE and ACCURATE written explanations where required.

• I understand the existence of any of the conditions listed on page 3 & 4 of this packet may result in my rejection from the selection process.

IF YOU HAVE ANY QUESTIONS, PLEASE CONTACT THE PERSONNEL UNIT FOR CLARIFICATION. I have read, understand and agree to the aforementioned conditions and criteria outlined above.

______Signature Date

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Scottsdale Police Department

DISQUALIFIERS Answer Yes or No to ALL the questions below regardless of the position for which you have applied.

AUTOMATIC DISQUALIFIERS – Non-Uniformed Positions 1. Ever been convicted of a felony within the last 5 years. Yes No 2. Been dishonorably discharged from the United States armed forces within the last 10 years. Yes No 3. Illegally produced, cultivated, or transported marijuana, a dangerous drug or narcotic for sale or Yes No sold the above-mentioned within the last 10 years. 4. Illegally used marijuana or marijuana topical CBD product for any purpose within the past 3 years. Yes No 5. Illegally used a dangerous drug or narcotic for any purpose within the past 7 years. Yes No

AUTOMATIC DISQUALIFIERS – Uniformed Positions (Police Officer, Police Aide, Detention Officer, Crime Scene Specialist, and Security Guard) 1. Ever been convicted of a felony or any offense that would be a felony if committed in Arizona. Yes No 2. Committed a felony, an offense that would be a felony if committed in this state, or an offense Yes No involving dishonesty, unlawful sexual misconduct, or physical violence while employed by a law enforcement agency. 3. Engaged in any conduct or pattern of conduct that tends to disrupt, diminish, or otherwise would Yes No jeopardize public trust in the law enforcement profession. 4. Been dishonorably discharged from the United States armed forces. Yes No 5. Been previously denied certified status, have certified status revoked or have current certified status suspended or have voluntarily surrendered certified status in lieu of possible disciplinary Yes No action in this or any other state if the reason for denial, revocation, suspension, or possible disciplinary action was or would be a violation of R13-4-109(A) if committed in Arizona. 6. Illegally possessed, produced, cultivated, or transported marijuana for sale or sold marijuana. Yes No 7. Illegally possessed or used marijuana or topical CBD product for any purpose within the past 3 Yes No years. 8. Illegally possessed or used marijuana other than for experimentation. Experimentation is defined Yes No as not exceeding a total of 20 times lifetime or exceeding 5 times, since attaining the age of 21. 9. Ever illegally possessed or used marijuana while employed or appointed as a peace officer. Yes No 10. Illegally sold, produced, cultivated, or transported for sale a dangerous drug or narcotic. Yes No 11. Illegally used a dangerous drug or narcotic, other than marijuana, for any purpose within the past Yes No 7 years. 12. Ever illegally used a dangerous drug or narcotic other than for experimentation. Experimentation is defined as not exceeding a total of 5 times lifetime or exceeding one time, since attaining the age of 21. (This includes, but is not limited to, cannabis edibles/ liquids/ vapors, non-topical CBD Yes No products, cocaine/crack, heroin, opium, morphine, LSD/acid, methamphetamine/speed, mescaline, or derivatives thereof). Use of non-prescription steroids since Jan.1, 1994, shall fall under the same restrictions. 13. Ever possessed or used a dangerous drug or narcotic while employed or appointed as a peace Yes No officer. 14. Have a pattern of abusing prescription medication. Yes No 15. Had excessive traffic violations within the past 3 years. Yes No 16. Lied during any stage of Scottsdale Police Department’s hiring process, falsified any information Yes No on the application or background questionnaire.

PLEASE CONFIRM THAT YOU HAVE READ, UNDERSTOOD, AND PROVIDED TRUTHFUL RESPONSES TO THE ABOVE STATED DISQUALIFIERS BY SIGNING BELOW:

Signature Date Rev 5.03.19 – BG Questionnaire ______Page 3 of 44

Scottsdale Police Department

GROOMING STANDARDS POLICY

Employees must follow this policy at all times when representing the department (including trainings, meetings, etc.). Command staff personnel have final discretion when determining the appropriateness regarding any identified conflict.

TATTOOS • Prohibits employees from exhibiting tattoos that are obscene, sexual, racial, or religiously discriminatory. • Prohibits excessive visible tattoos. Excessive is defined as: • Covering 1/3 or more of exposed body part. o Employees with tattoos covering 1/3 or more of an exposed body part are required to cover the tattoos with long sleeve shirts or pants while in the performance of their duties. • Visible on hands, face or neck. o Exception: Uniformed employees are permitted one “ring style” finger tattoo per hand, between the 2nd and 3rd knuckle, closest to the hand where a ring would be normally worn. o Exception: Employees in a non-uniformed position are permitted to have discreet visible tattoos on the back, and/or side of the neck, behind the ear, and on hands.

MUTILATIONS • Prohibits enlarged or stretched holes, other visible mutilations, markings, or intentional scaring of the ears, face, or mouth to include tongue, lips, gums and teeth, or neck. • Prohibits visible dental veneers or permanent dental inserts with a prominent and unnatural appearance; such as jewels, contrasting caps, initials, or other unnatural dental designs. • Prohibits the display of foreign objects, piercings, or jewelry inserted around or under the exposed skin. • Prohibits the possession of an intentionally split or forked tongue.

JEWELRY Conservative jewelry may be worn when appropriate to the assignment and when it does not create a safety risk. • Prohibits male and female uniformed employees from wearing more than three rings. • Prohibits male employees from wearing earrings. • Prohibits female uniformed employees from wearing large earrings, including hoops and/or dangles. Exception: All female employees are permitted to wear one pair of stud earrings. o MAKE-UP • Prohibits all female employees from wearing non-conservative make-up.

HAIR AND FACIAL HAIR • Prohibits male uniformed employees from cuts that touch the collar or ears. • Prohibits male employees from mustaches that are unprofessional, untidy and untrimmed. • Prohibits male uniformed employees from wearing other facial hair, such as goatees and beards, unless authorized by the Chief of Police. • Prohibits male employees from wearing long, untrimmed beards. o The style must be consistent with professional appearance standards. • Prohibits female uniformed employees from wearing hair that interferes with assigned duties. o Hair cannot extend beyond the top of the shoulders. o Restrain hair using pins, braids, or ponytails. Coil or fold braids or ponytails under and/or close to the head to enhance safety. Style must be consistent with professional appearance standards. o Requests for religious accommodations are approved on a case by case basis.

I HAVE READ AND UNDERSTAND THE ABOVE GROOMING STANDARDS POLICY

Print Name Sign Name Date Rev 5.03.19 – BG Questionnaire ______Page 4 of 44

Scottsdale Police Department

ITEMS NEEDED FOR BACKGROUND PACKET

APPLICANT IS REQUIRED TO SUBMIT THE FOLLOWING ITEMS ALONG WITH THIS COMPLETED BACKGROUND QUESTIONNAIRE BY THE DATE PROVIDED IN THE BACKGROUND INVITE EMAIL:

• AZPOST Personal History Form (Police Officer Applicants ONLY) – all pages must be originals.

• Current Credit Report (within the past 90 days) (from one of the major credit bureaus: Experian, Equifax or TransUnion) – A complete credit history is required, not just Credit Summary. Credit Score is not required.

• Compose separate one-paragraph memorandums for each topic below. Each individual memo should be on a separate piece of paper, may be handwritten or typed, and addressed in the format below:

Date: Date memorandum was written To: Background Investigator From: Your name Regarding: TOPIC

Memorandum #1: Intent and Interest in the position you are applying for with the City of Scottsdale. Topics that should be addressed in this memorandum are: 1) Why you want to become a… (the position you are applying for: police officer, dispatcher, detention officer, etc.); 2) Why you selected the Scottsdale Police Department.

Memorandum #2: What you have done to prepare for the position for which you are applying.

Memorandum #3: What your current fitness regimen/routine is (to include running distance and time) - Police Officer Applicants ONLY

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Scottsdale Police Department

1. PERSONAL DATA Last Name First Name Middle Name

Other Names You Ever Used & Year(s) Used (Include Maiden Name)

Date of Birth Place of Birth (City & State)

Current Home Address City State Zip Code

Age Social Security Number Sex Race Height Weight Hair Color Eye Color

Driver’s License Number & State Primary Phone Secondary Phone

United States Citizen Certificate of Naturalization Number Date of Issuance Yes No N/A N/A Primary Email Address Secondary Email Address

1A. List scars, marks and/or tattoos: N/A Description Body Location

Description Body Location

Description Body Location

Description Body Location

Description Body Location

Description Body Location

Description Body Location

1B. Are any of your tattoos considered offensive, racist, sexist or identifies you as a gang member? N/A Yes No If yes, provide explanation on supplemental pages. 1C. List visible body piercings, aside from a single ear(s) piercing: N/A Piercing Location Piercing Location Piercing Location Piercing Location

1D. List names and relationships of person(s) you currently live with: Name Relationship Name Relationship

Name Relationship Name Relationship

Name Relationship Name Relationship

Please use supplemental pages at the end of this questionnaire to provide additional information. Indicate item number & letter i.e.: 2B, 6C, 13C, etc.

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Scottsdale Police Department

1E. Social Media - list all social media accounts and internet social websites you have ever used (i.e. Facebook, N/A Twitter, Instagram, etc.). Social Media Application User Name Related Email Address

Social Media Application User Name Related Email Address

Social Media Application User Name Related Email Address

Social Media Application User Name Related Email Address

1F. Beginning with your present address, list all residences you have lived during the past 10 years. Include any military addresses if applicable. Dates MO/YR Street Address City County State Zip Code From To

Present

2. RELATIONSHIPS 2A. Marital Status: Single Married Widowed Divorced Other Spouse/Significant Other Name Other Names Used (Including Maiden) Date of Birth

Social Security Number Phone Date Married (If Applicable) Email Address Total Years Together

Occupation Employer

Please use supplemental pages at the end of this questionnaire to provide additional information. Indicate item number & letter i.e.: 2B, 6C, 13C, etc. Rev 5.03.19 – BG Questionnaire ______Page 7 of 44

Scottsdale Police Department

2B. If applicable, list former marriages: Name Address (Street, City, State, Zip)

Phone number Date of Birth Occupation Date Married Date Divorced

Name Address (Street, City, State, Zip)

Phone Number Date of Birth Occupation Date Married Date Divorced

2C. List all children (biological, adoptive, step, etc.): N/A Child’s Name Date of Birth Address (Street, City, State, Zip) Phone Number

2D. List immediate relatives (excluding children) including those deceased (mother, father, siblings, etc.): Name Relationship Address (Street, City, State, Zip) Phone Number

Please use supplemental pages at the end of this questionnaire to provide additional information. Indicate item number & letter i.e.: 2B, 6C, 13C, etc.

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Scottsdale Police Department

2E. List all persons you have lived with during the past 10 years (excluding those listed in section 2A., 2B., 2C & 2D): Name Address (Street, City, State, Zip) Phone Number Relationship

2F. List all acquaintances who work for or volunteer with the City of Scottsdale: N/A Name Job Title Relationship

2G. List all relatives who are employed in law enforcement: N/A Name Job Title / Agency Relationship

3. POSITION AWARENESS

3A. Is the position you applied for a “shift work” position? Yes No 3B. If the position is not “shift work”, do you have a general idea of when you will be required to N/A Yes No work? 3C. If the position you have applied is a “shift work” position, you need to be aware that the Scottsdale Police Department provides services 24 hours a day, 7 days a week, 365 days per year. N/A Yes No Would you be willing to accept any assignment including; rotating shifts, various days off, weekends, holidays, and when necessary, overtime, to meet the needs of the department?

Please use supplemental pages at the end of this questionnaire to provide additional information. Indicate item number & letter i.e.: 2B, 6C, 13C, etc. Rev 5.03.19 – BG Questionnaire ______Page 9 of 44

Scottsdale Police Department

3D. Have you reviewed the minimum salary for this position? N/A Yes No

3E. Do you understand the job description and duties? Yes No

3F. Do you have any concerns with the work schedule, salary, or job duties? If yes, provide explanation below. Yes No

4. EDUCATION AND TRAINING 4A. Indicate by checking the boxes below if you have any of the following: G.E.D. Certificate High School Diploma Associate Degree Bachelor Degree Master Degree Doctorate Degree In chronological order, list all high schools, colleges, trade schools, and universities you have attended. Applicants must provide a certified copy of their transcript for each listed institution. Certified transcripts must be delivered to the Personnel Unit in a sealed and certified envelope from the institution at the time of the background interview. Dates Attended Name of Institution Address (Street, City, Certificate / Degree Major State, Zip) Type or Credit Hours Received

4B. How do/did you fund your college education? N/A Loans Financial Aid Parents/Family Self-pay Scholarship(s) GI Bill 4C. Have you ever been suspended, disciplined, expelled, or placed on probation for any reason from any high Yes No school or institution of higher learning? If yes, provide explanation on supplemental pages. 4D. List any certifications or special licenses. Include certification numbers where applicable. N/A Date Completed Type of Certification Certification Number Certification Expiration

Please use supplemental pages at the end of this questionnaire to provide additional information. Indicate item number & letter i.e.: 2B, 6C, 13C, etc. Rev 5.03.19 – BG Questionnaire ______Page 10 of 44

Scottsdale Police Department

4E. List any language, other than English, that you speak, read, and/or write. Select fluency for each. N/A Language Speak (Fluency) Read (Fluency) Write (Fluency) Beginning Beginning Beginning Intermediate Intermediate Intermediate Advanced Advanced Advanced Beginning Beginning Beginning Intermediate Intermediate Intermediate Advanced Advanced Advanced Beginning Beginning Beginning Intermediate Intermediate Intermediate Advanced Advanced Advanced

5. REFERENCES List five (5) adult references that have known you for at least the last 3 years and whom you have regular contact with (in person, texts, social media, etc.). Do not list relatives, employers, or supervisors (current or former). Email addresses must be included. 1 Name Address (Street, City, State, Zip) Residence Business

Email Address Primary Phone Secondary Phone

Occupation Years Known? Relationship

2 Name Address (Street, City, State, Zip) Residence Business

Email Address Primary Phone Secondary Phone

Occupation Years Known? Relationship

3 Name Address (Street, City, State, Zip) Residence Business

Email Address Primary Phone Secondary Phone

Occupation Years Known? Relationship

4 Name Address (Street, City, State, Zip) Residence Business

Email Address Primary Phone Secondary Phone

Occupation Years Known? Relationship

5 Name Address (Street, City, State, Zip) Residence Business

Email Address Primary Phone Secondary Phone

Occupation Years Known? Relationship

Please use supplemental pages at the end of this questionnaire to provide additional information. Indicate item number & letter i.e.: 2B, 6C, 13C, etc.

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Scottsdale Police Department

6. EMPLOYMENT 6A. List all employment during your lifetime. Begin with your present or most recent employer and work backward in chronological order. Be sure to include periods of time in school, military service, unemployment, temporary assignments, internships, volunteer service, and part-time employment. If you worked in more than one position for an employer, list each position separately. If you need additional space, use the supplemental pages. If possible, list your immediate supervisor’s phone number, fax number, and email address. Otherwise, provide all contact information for the company or business. Explain in detail your reason for leaving your employer.

Month / Year Full Time Part Time Seasonal Volunteer Intern From To Employer

Job Title Address (Street, City, State, Zip)

Supervisor Name Supervisor’s Email Address Work Number Work Fax Number

Description of Your Duties

Reason For Leaving

Month / Year Full Time Part Time Seasonal Volunteer Intern From To Employer

Job Title Address (Street, City, State, Zip)

Supervisor Name Supervisor’s Email Address Work Number Work Fax Number

Description of Your Duties

Reason For Leaving

Month / Year Full Time Part Time Seasonal Volunteer Intern From To Employer

Job Title Address (Street, City, State, Zip)

Supervisor Name Supervisor’s Email Address Work Number Work Fax Number

Description of Your Duties

Reason For Leaving

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Scottsdale Police Department

Month / Year Full Time Part Time Seasonal Volunteer Intern From To Employer

Job Title Address (Street, City, State, Zip)

Supervisor Name Supervisor’s Email Address Work Number Work Fax Number

Description of Your Duties

Reason For Leaving

Month / Year Full Time Part Time Seasonal Volunteer Intern From To Employer

Job Title Address (Street, City, State, Zip)

Supervisor Name Supervisor’s Email Address Work Number Work Fax Number

Description of Your Duties

Reason For Leaving

Month / Year Full Time Part Time Seasonal Volunteer Intern From To Employer

Job Title Address (Street, City, State, Zip)

Supervisor Name Supervisor’s Email Address Work Number Work Fax Number

Description of Your Duties

Reason For Leaving

Please use supplemental pages at the end of this questionnaire to provide additional information. Indicate item number & letter i.e.: 2B, 6C, 13C, etc.

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Scottsdale Police Department

Month / Year Full Time Part Time Seasonal Volunteer Intern From To Employer

Job Title Address (Street, City, State, Zip)

Supervisor Name Supervisor’s Email Address Work Number Work Fax Number

Description of Your Duties

Reason For Leaving

Month / Year Full Time Part Time Seasonal Volunteer Intern From To Employer

Job Title Address (Street, City, State, Zip)

Supervisor Name Supervisor’s Email Address Work Number Work Fax Number

Description of Your Duties

Reason For Leaving

Month / Year Full Time Part Time Seasonal Volunteer Intern From To Employer

Job Title Address (Street, City, State, Zip)

Supervisor Name Supervisor’s Email Address Work Number Work Fax Number

Description of Your Duties

Reason For Leaving

Please use supplemental pages at the end of this questionnaire to provide additional information. Indicate item number & letter i.e.: 2B, 6C, 13C, etc.

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Scottsdale Police Department

Month / Year Full Time Part Time Seasonal Volunteer Intern From To Employer

Job Title Address (Street, City, State, Zip)

Supervisor Name Supervisor’s Email Address Work Number Work Fax Number

Description of Your Duties

Reason For Leaving

Month / Year Full Time Part Time Seasonal Volunteer Intern From To Employer

Job Title Address (Street, City, State, Zip)

Supervisor Name Supervisor’s Email Address Work Number Work Fax Number

Description of Your Duties

Reason For Leaving

Month / Year Full Time Part Time Seasonal Volunteer Intern From To Employer

Job Title Address (Street, City, State, Zip)

Supervisor Name Supervisor’s Email Address Work Number Work Fax Number

Description of Your Duties

Reason For Leaving

Please use supplemental pages at the end of this questionnaire to provide additional information. Indicate item number & letter i.e.: 2B, 6C, 13C, etc.

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Scottsdale Police Department

6B. Are you currently employed? Yes No

6C. Is your current employer/supervisor aware of this application? N/A Yes No 6D. Do you prefer contact with your present employer be delayed? If yes, provide explanation N/A Yes No on supplemental pages. 6E. Did you include all past employers as requested? If no, provide explanation on supplemental pages. Yes No 6F. Have you ever walked off a job or quit without giving a two-week notice? If yes, provide explanation on Yes No supplemental pages. 6G. Have you “called in sick” within the last year when you or a family member were not actually ill? If yes, Yes No provide explanation on supplemental pages. 6H. Have you been able to follow direct orders, even if you did not agree with the orders? If no, provide Yes No explanation on supplemental pages. 6I. Have you been involved in any physical or verbal confrontation, during your employment, that would be Yes No considered unprofessional with any of the following: If yes, provide explanation on supplemental pages.

Co-workers? Yes No Supervisors? Yes No Customers? Yes No

6J. Have you ever let any personal problems interfere with your job performance? If yes, provide explanation on Yes No supplemental pages. 6K. Have you ever taken or borrowed anything from an employer without permission to include money, Yes No merchandise or time? If yes, provide estimated value and explanation on supplemental pages. 6L. Have you ever deliberately overcharged, cheated or short changed a customer? If yes, provide estimated Yes No value and explanation on supplemental pages. 6M. Have you ever stolen anything from a co-worker? If yes, provide estimated value and explanation on Yes No supplemental pages. 6N. Have you ever given away or given any discounts on merchandise or services, at any job, against company policy? (i.e. free drinks, free food, equipment, merchandise) If yes, provide estimated value and explanation Yes No on supplemental pages. 6O. Have you ever kept without permission any supplies, tools, or other equipment that was issued to you Yes No after you left that employer? If yes, provide estimated value and explanation on supplemental pages. 6P. Have you ever accidentally damaged/broken any property belonging to an employer that you did not Yes No report? If yes, provide estimated value and explanation on supplemental pages. 6Q. Have you ever purposefully damaged any property belonging to an employer for any reason? If yes, Yes No provide estimated value and explanation on supplemental pages. 6R. Have you ever slept, while at work, without permission when you were supposed to be working? If yes, Yes No provide explanation on supplemental pages. 6S. Have you ever accessed, sold, shared, deleted or destroyed any confidential information, to include Yes No electronic information, when you were not authorized to do so? If yes, provide explanation on supplemental pages. 6T. Have you ever falsified employment documents to include reports, logs, job injury reports, sick leave Yes No reports? If yes, provide explanation on supplemental pages. 6U. Have you ever been counseled or warned regarding comments you made about someone’s race, gender, Yes No religion, nationality, or sexual orientation? If yes, provide explanation on supplemental pages. 6V. Have you had any difficulty working with, being supervised by, or dealing with, the opposite sex or those of Yes No different origin, race, religion, or nationality? If yes, provide explanation on supplemental pages.

Please use supplemental pages at the end of this questionnaire to provide additional information. Indicate item number & letter i.e.: 2B, 6C, 13C, etc.

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Scottsdale Police Department

6W. Have you ever filed a lawsuit or an administrative claim against a former employer for any reason? If Yes No yes, provide explanation on supplemental pages. Employer Date: Reason: Name: Employer Date: Reason: Name: 6X. Have you ever consumed alcohol or illegal drugs while at work, on duty, or at any official or unofficial work location, including buildings, vehicles, parking lots, or any other work location? If yes, provide Yes No explanation on supplemental pages. 6Y. Have you ever worked while under the influence of alcohol or any illegal drug? If yes, provide explanation on Yes No supplemental pages. 6Z. Have you ever gone to work within six hours of consuming alcohol? If yes, provide explanation on supplemental Yes No pages. 6AA. Have you ever been warned by an employer about the impact your alcohol consumption, prescription drug use, and/or illegal drug had on your work performance? If yes, provide explanation on supplemental Yes No pages. 6BB. Have you ever missed work or been late to work due to alcohol consumption, prescription drug use, Yes No and/or illegal drug usage? If yes, how many times and when? Provide explanation on supplemental pages. 6CC. Have you ever committed or been accused of sexual discrimination? If yes, provide explanation on Yes No supplemental pages. 6DD. Have you ever accessed, attempted to access, or viewed pornography from any electronic device, whether it was personally owned or owned by your employer, while at work, on duty, or at any official Yes No or unofficial work location? If yes, provide explanation on supplemental pages. 6EE. Have you ever engaged in a sexual act, either with someone else or alone, in the form of masturbation, while at work, on duty, or at any official or unofficial work location? If yes, provide explanation on Yes No supplemental pages. 6FF. Are there any of your past employers that would give you a poor employment reference based on Yes No performance or behavior? If yes, provide explanation on supplemental pages. 6GG. Have you ever received any verbal or written warnings due to performance or behavior related issues? Yes No If yes, provide explanation on supplemental pages. 6HH. Have you ever received a suspension, demotion, transfer, or garnishment of wages due to performance Yes No or behavior related issues? If yes, provide explanation on supplemental pages. 6II. Have you ever been fired or terminated from employment? If yes, provide explanation on supplemental pages. Yes No 6JJ. Have you ever been asked to resign or quit from a place where you worked in lieu of termination? If yes, Yes No provide explanation on supplemental pages. 6KK. Have you ever resigned or quit because you thought you were going to be fired or terminated? If yes, Yes No provide explanation on supplemental pages. 6LL. What was your performance rating on your last two performance evaluations?

Rating Period: Overall Evaluation Rating:

Rating Period: Overall Evaluation Rating: 6MM. Have you ever been exposed to any high stress or extreme emergency condition in any previous employment Yes No setting? If yes, provide explanation on supplemental pages. 6NN. Is there any information about your employment that we have not discussed? If yes, provide explanation on Yes No supplemental pages. Please use supplemental pages at the end of this questionnaire to provide additional information. Indicate item number & letter i.e.: 2B, 6C, 13C, etc.

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6OO. Have you ever applied to, or been employed by the City of Scottsdale in any capacity as a paid employee, Yes No intern, or volunteer? If yes, list below. Position Title Department Date Offered / Accepted / Denied

If a position was not offered or accepted, provide an explanation below.

7. LAW ENFORCEMENT AGENCY APPLICATIONS

7A. List ALL law enforcement agency applications you have ever submitted: N/A Agency Name Date Position Status 1 Application Written / Physical Oral Board Background Polygraph Medical Psychological Command Practical Test Agility Staff Review Contact Person / Phone Email Address Background Investigator:

Agency Name Date Position Status 2

Application Written / Physical Oral Board Background Polygraph Medical Psychological Command Practical Test Agility Staff Review Contact Person / Phone Email Address Background Investigator:

Agency Name Date Position Status 3

Application Written / Physical Oral Background Polygraph Medical Psychological Command Practical Test Agility Board Staff Review Contact Person / Phone Email Address Background Investigator:

Agency Name Date Position Status 4

Application Written / Physical Oral Background Polygraph Medical Psychological Command Practical Test Agility Board Staff Review Contact Person / Phone Email Address Background Investigator:

Please use supplemental pages at the end of this questionnaire to provide additional information. Indicate item number & letter i.e.: 2B, 6C, 13C, etc.

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Agency Name Date Position Status 5

Application Written / Physical Oral Background Polygraph Medical Psychological Command Practical Test Agility Board Staff Review Contact Person / Phone Email Address Background Investigator:

Agency Name Date Position Status 6

Application Written / Physical Oral Background Polygraph Medical Psychological Command Practical Test Agility Board Staff Review Contact Person / Phone Email Address Background Investigator:

Agency Name Date Position Status 7

Application Written / Physical Oral Background Polygraph Medical Psychological Command Practical Test Agility Board Staff Review Contact Person / Phone Email Address Background Investigator:

Agency Name Date Position Status 8

Application Written / Physical Oral Background Polygraph Medical Psychological Command Practical Test Agility Board Staff Review Contact Person / Phone Email Address Background Investigator:

Agency Name Date Position Status 9

Application Written / Physical Oral Background Polygraph Medical Psychological Command Practical Test Agility Board Staff Review Contact Person / Phone Email Address Background Investigator:

Agency Name Date Position Status 10

Application Written / Physical Oral Background Polygraph Medical Psychological Command Practical Test Agility Board Staff Review Contact Person / Phone Email Address Background Investigator:

Agency Name Date Position Status 11

Application Written / Physical Oral Background Polygraph Medical Psychological Command Practical Test Agility Board Staff Review Contact Person / Phone Email Address Background Investigator:

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7B. List ALL polygraph exam(s) you have ever taken below. If needed, provide additional information on supplemental pages.

Date Employer Name Purpose Location Result

7C. Have you ever been disqualified during the application process from any law enforcement agency? If yes, Yes No provide explanation on supplemental pages.

8. DRIVING

8A. List all current driver’s licenses (include other countries): State License Number Type/ Class Endorsements Expiration

8B. List all previous driver’s licenses (include other countries): N/A State License Number Type / Class Endorsements Expiration

8C. List all traffic warnings and citations: N/A Disposition (i.e. Paid fine, Traffic Date Violation Description Police Agency City/ County / State School, Dismissed)

Please use supplemental pages at the end of this questionnaire to provide additional information. Indicate item number & letter i.e.: 2B, 6C, 13C, etc. Rev 5.03.19 – BG Questionnaire ______Page 20 of 44

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8D. List all traffic collisions you have been involved in as the driver whether cited or not: N/A Disposition (i.e. No Date Violation Description Police Agency City / County / State Citation, No Police Report, H&R, etc.)

8E. List all vehicles registered to you: N/A Year Make Model License Plate # State

8F. Has there ever been a time that you drove or owned an uninsured vehicle? If yes, provide explanation on Yes No supplemental pages. 8G. Has your automobile insurance ever been cancelled for any reason, at any time? If yes, provide explanation Yes No on supplemental pages.

8H. Have you ever been refused automobile insurance? If yes, provide explanation on supplemental pages. Yes No

8I. Are your vehicle(s) currently registered? If no, provide explanation on supplemental pages. Yes No

8J. Have you ever failed to pay any traffic court ordered fine? If yes, provide explanation on supplemental pages. Yes No 8K. Has your driver’s license ever been revoked, suspended, or cancelled for any reason? If yes, list below and Yes No provide explanation on supplemental pages. Date of Date of Reason for Suspension/Revocation/Cancellation: Incident: Reinstatement: Date of Date of Reason for Suspension/Revocation/Cancellation: Incident: Reinstatement: 8L. As a driver, have you ever been involved in any collision that resulted in serious injury/death? If yes, Yes No provide explanation on supplemental pages. 8M. As a driver, have you ever been involved in any collision that was not reported to the police or to the other party. (It could be as simple as backing into another vehicle resulting in minor damage, or more serious Yes No such as causing extensive damage to property or serious injury/death to another person.) If yes, provide explanation on supplemental pages. 8O. As a driver, have you ever driven recklessly (i.e. criminal speeding, weaving through traffic, running Yes No another vehicle off the roadway, etc.)? If yes, provide explanation on supplemental pages. 8P. As a driver, have you ever committed road rage (i.e. chasing another vehicle, reckless driving, brandishing Yes No a weapon, any verbal confrontation, etc.)? If yes, provide explanation on supplemental pages. 8Q. As a driver, have you ever been involved in a collision involving alcohol/drugs? If yes, provide explanation on supplemental pages. Yes No Please use supplemental pages at the end of this questionnaire to provide additional information. Indicate item number & letter i.e.: 2B, 6C, 13C, etc. Rev 5.03.19 – BG Questionnaire ______Page 21 of 44

Scottsdale Police Department

8R. Have you ever operated a motor vehicle while under the influence of alcohol or drugs (prescribed, illicit, or over the counter) when you knew you shouldn’t be driving? If yes, provide explanation on supplemental pages to include the following: • Total number of times Yes No • Location (City and State) of each incident • Date(s) when each incident occurred • Details of each incident (i.e. Did it result in collision? Was law enforcement involved?) • Any other factors you believe are relevant 8S. Have you ever been stopped by the police because you were suspected of driving under the influence of alcohol or drugs? If yes provide explanation on supplemental pages to include: • Date(s) when each incident occurred • Location (City and State) of each incident • Name of police department that stopped you Yes No • The testing conducted (i.e. Field Testing, HGN – Pen Test, Breath Test, etc.) • The results of the BAC/Blood tests, if conducted • Disposition of the traffic stop (i.e. Criminal Citation, Arrest, Released, etc.) • Any other factors you believe are relevant

9. ALCOHOL 9A. Have you consumed alcohol under 21? If yes, provide explanation on supplemental pages to include: • The legal drinking age at the time you consumed the alcohol illegally Yes No • The age(s)you consumed alcohol illegally • The frequency you consumed alcohol illegally 9B. Has your alcohol consumption ever caused problems at home, at work, in your personal life, or with Yes No your driving privileges? If yes, provide explanation on supplemental pages. 9C. Have you ever been so intoxicated in a public place that you were unable to take care of yourself? If yes, provide explanation on supplemental pages to include: Yes No • Date(s) when each incident occurred • Description of the Circumstances 9D. Have you ever experienced a blackout that involved alcohol consumption? If yes, provide explanation on supplemental pages to include: Yes No • Date(s) when each incident occurred • Description of the Circumstances

10. DRUGS 10A. Answer each of the following questions for each substance you have tried, used or experimented with. Experimentation includes, but is not limited to, smoking, swallowing, tasting, inhaling, inserting, ingesting or injecting: Please make sure to answer all questions listed in each column (table continued the next page). Have you ever bought, Have you ever If “Yes” How many sold, produced, Date tried, used or how many times after Date First Type of Drug cultivated, smuggled, or Last experimented times the age of Used transported for sale or Used with? total? 21? personal gain? Marijuana or Topical CBD

Marijuana Products Yes No Yes No Cannabis Edibles/ Liquids/ Vapors / Non-Topical CBD Yes No Yes No Products Hash / Hashish Yes No Yes No

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Have you ever bought, Have you ever If “Yes” How many sold, produced, Date tried, used or how many times after Date First Type of Drug cultivated, smuggled, or Last experimented times the age of Used transported for sale or Used with? total? 21? personal gain? Spice / K2 Yes No Yes No Opium / Heroin Yes No Yes No Cocaine / Crack Yes No Yes No Amphetamines Yes No Yes No Methamphetamine / Speed / Yes No Yes No Crystal MDMA / Molly / Ecstasy Yes No Yes No Bath Salts Yes No Yes No GHB / Rohypnol / Roofies Yes No Yes No Ketamine / Special K Yes No Yes No PCP / Angel Dust Yes No Yes No Salvia Divinorum / Salvia Yes No Yes No LSD / Acid Yes No Yes No Mescaline / Peyote Yes No Yes No Mushrooms / Psilocybin Yes No Yes No DXM / Robo / Triple C Yes No Yes No Anabolic Steroids (each injection or pill in a cycle is a Yes No Yes No use) Inhalants: Glue / Paint / Air Yes No Yes No Freshener / Whippets, etc. Prescription Drug Abuse: Barbiturates, Valium, Xanax, Ambien, Codeine, Morphine, Yes No Yes No Methadone, Oxycontin, Percocet, Vicodin, etc.

10B. If you answered yes to any of the areas in section 10A, provide a full explanation for each drug used on supplemental pages to include the following: • What was the first date used? • What was the last date used? • What was the total times used? • What was your motivation to use the drug? • How was the drug obtained (i.e. purchased, contributed to purchase, or provided by others)? List all that apply. • Why you stopped using the drug. • Any other factors you believe are relevant.

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10C. Have you ever been present when someone else bought or sold marijuana or any other illegal drug(s)? Yes No If yes, provide explanation on supplemental pages. 10D. Have you ever told anyone where to buy marijuana or any other illegal drug(s)? If yes, provide Yes No explanation on supplemental pages. 10E. Has anyone in your family ever used marijuana or any other illegal drug(s)? If yes, provide explanation on supplemental pages. Yes No 10F. Do you currently live with anyone who uses marijuana or any other illegal drugs? If yes, provide Yes No explanation on supplemental pages. 10G. Have you knowingly allowed anyone to possess or use marijuana or any other illegal drugs in your Yes No home or vehicle? If yes, provide explanation on supplemental pages. 10H. When was the last time you were in the presence of anyone using marijuana or any other illegal N/A drug(s)? Provide Full Explanation below.

10I. Have you ever tried, used, or experimented with your own or someone else’s prescription medication Yes No for the intent or purpose of getting high? If yes, list below and provide explanation on supplemental pages.

Drug Name 1st Time Last Time Max Times Tried/Used

10J. Have you ever used someone else’s prescription medication for any reason? If yes, list below and provide Yes No explanation on supplemental pages. Max Times Drug Type 1st Time Last Time Why Used? Tried/Used

10K. Have you used any form of someone else’s ADD/ADHD medication (i.e. Adderall, Ritalin, or Yes No Concerta)? If yes, list below and provide explanation on supplemental pages. Max Times Drug Type 1st Time Last Time Why Used? Tried/Used

Please use supplemental pages at the end of this questionnaire to provide additional information. Indicate item number & letter i.e.: 2B, 6C, 13C, etc. Rev 5.03.19 – BG Questionnaire ______Page 24 of 44

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10L. Have you ever forged or altered a prescription for drugs? If yes, provide explanation on supplemental Yes No pages. 10M. Have you ever purchased, contributed to a purchase, or traded for illegal prescription drugs? If yes, Yes No provide explanation on supplemental pages. 10N. Have you ever sold, produced, smuggled, or transported for sale or personal gain illegal prescription Yes No drugs? If yes, provide explanation on supplemental pages. 10O. Have you ever purchased prescription drugs in another country and then brought them back to the Yes No United States illegally (i.e. steroids)? If yes, provide explanation on supplemental pages. 10P. Have you ever given away or shared your prescription medication with anyone? If yes, provide explanation on supplemental pages to include the following: • Date(s) when each incident occurred • Name/Type of prescription medication Yes No • Quantity given away/shared in each incident • Purpose of giving away/sharing the prescription • Whether you were compensated in any manner (i.e. paid, gift, service, etc.?) • Any other factors you believe are relevant 10Q. Were you compensated, in any manner, for giving away or sharing your prescription N/A Yes No medication? If yes, provide explanation on supplemental pages. 10R. Have you ever tried, used, or experimented with any form of illegal drugs or substance that has not Yes No been mentioned? If yes, provide explanation on supplemental pages. 10S. Have you ever tried, used, or experimented with any substance that you did not know what it was when Yes No you tried it? If yes, provide explanation on supplemental pages.

11. CRIMINAL HISTORY/ACTIVITY 11A. As an adult or juvenile, have you ever been contacted, detained, questioned or interviewed by the police or private security because of an incident, event or investigation? If yes, provide explanation on Yes No supplemental pages. 11B. Have the police ever responded to your home? If yes, provide explanation on supplemental pages. Yes No 11C. Have you ever spent time in a police station for any reason other than employment purposes? If yes, Yes No provide explanation on supplemental pages. 11D. Have you been issued a “notice to appear” citation / summons for a crime to include criminal traffic Yes No violations? If yes, provide explanation on supplemental pages. 11E. Have you ever been arrested, booked, fingerprinted, or charged with any crime? If yes, list below and Yes No provide explanation on supplemental pages. When Where Explanation Disposition

11F. Have you ever been to court for any criminal matter? If yes, provide explanation on supplemental pages. Yes No 11G. Do you now, or have you ever had, any outstanding criminal warrants against you? If yes, provide Yes No explanation on supplemental pages. 11H. Have you ever been convicted of a crime? If yes, provide explanation on supplemental pages. Yes No

Please use supplemental pages at the end of this questionnaire to provide additional information. Indicate item number & letter i.e.: 2B, 6C, 13C, etc.

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11I. Are you now, or have you ever been, on parole or probation for any offense? If yes, provide explanation on supplemental pages. Yes No 11J. Have you ever failed to comply with court directed fines, community service, diversion programs or mandatory classes? If yes, provide explanation on supplemental pages. Yes No 11K. Is your ability to carry a firearm limited, or have you ever been denied a permit to carry a firearm? If yes, provide explanation on supplemental pages. Yes No 11L. Have any of your immediate relatives or spouse(s) ever been charged with a crime, arrested, convicted, and/or imprisoned in any state? If yes, provide explanation on supplemental pages. Yes No 11M. Have you ever had any contact with anyone, other than immediate relatives, who is now, or has ever been incarcerated in any manner? If yes, provide explanation on supplemental pages. Yes No 11N. When was the last time you were involved in a physical fight or confrontation? Were there any injuries? What was the cause? (Continue explanation on supplemental pages) N/A

11O. Do you have any knowledge of any unreported or unsolved serious crimes (i.e. rape, homicide, burglary, kidnapping, robbery, arson, forgery, crimes against children)? If yes, provide explanation on Yes No supplemental pages. 11P. At any time, have you ever committed, attempted to commit, made plans to commit, participated, been present, been accused, or received any benefit during any of the following: If yes, provide explanation on supplemental pages. 1. Homicide Yes No 2. Assault Yes No 3. Kidnapping Yes No 4. Stalking Yes No 5. Criminal Damage Yes No 6. Criminal Trespassing Yes No 7. Disorderly Conduct (was weapon involved?) Yes No 8. Robbery Yes No 9. Burglary Yes No 10. Fraud (intentionally written any bad checks, illegally used a credit or debit card, received any money or benefit from a false insurance claim, sold downloaded music/movies for profit, used or Yes No obtained fake ID, etc.) 11. Forgery (forged another person’s signature for monetary gain without their permission, forged Yes No written documents, check washing, etc.) 12. Arson Yes No 13. Hate Crimes (group, race, or religion) Yes No 14. Auto Theft Yes No 15. Joy Riding (taking a vehicle without owner permission) Yes No 16. Theft (shoplifting, changing price tags, money, securities, car parts, street signs, lawn ornaments, the Yes No taking of anything that does not belong to you, etc.) 17. Theft of Services (downloading music or movies, cable or satellite TV, water, electricity, dine and Yes No dash, etc.) Please use supplemental pages at the end of this questionnaire to provide additional information. Indicate item number & letter i.e.: 2B, 6C, 13C, etc. Rev 5.03.19 – BG Questionnaire ______Page 26 of 44

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18. Knowingly bought, sold, or possessed stolen property Yes No 19. Bribery Yes No 20. Perjury (false swearing/false reporting) Yes No 21. Used a weapon to intimidate someone Yes No 22. Removed or altered serial numbers on a weapon or any other property Yes No 23. Carried a concealed weapon without a permit when a permit was required Yes No 24. Possessed, manufactured, or transported an illegal weapon or explosive (sawed-off shotgun, pipe bombs, dry ice bombs, MRE bombs, mortar type fireworks, conversion of semi-automatic, possessed Yes No a silencer, etc.) 25. Impersonated a police officer Yes No 26. Made a bomb threat Yes No 27. Provided alcohol to minors Yes No 28. Tortured or abused an animal, or been present when others did Yes No 29. Any game and fish violations (i.e. Hunting/fishing without a license, poaching, out of season) Yes No 30. Have you ever committed or been present during the commission of any criminal activity other than Yes No what has been specifically asked?

12. SEXUAL ACTIVITY Sexual contact means any direct or indirect touching or manipulating of any private part with any part of your body or any object. Private parts are genitals, anus or the female breast. 12A. Have you ever paid for a sexual act, either for yourself or for someone else? If yes, provide explanation on Yes No supplemental pages. 12B. Has anyone ever paid for you to receive a sexual act? If yes, provide explanation on supplemental pages. Yes No

12C. Have you ever been paid for a sexual act? If yes, provide explanation on supplemental pages. Yes No

12D. Have you ever paid for a call or escort service? If yes, provide explanation on supplemental pages. Yes No 12E. Have you ever been involved in any other activity involving prostitution or pimping? If yes, provide Yes No explanation on supplemental pages. 12F. Have you ever committed or been accused of committing sexual harassment? If yes, provide explanation Yes No on supplemental pages. 12G. Have you ever forced someone to kiss, touch, or have sexual contact with you? If yes, provide explanation Yes No on supplemental pages. 12H. Have you ever used, or attempted to use, a position of authority, power, or trust to engage another in Yes No any sexual contact? If yes, provide explanation on supplemental pages. 12I. Have you ever taken sexual advantage of a person who was incapacitated (i.e. asleep, intoxicated, drugged, medical condition, mental impairment, young child incapable of giving consent, death, etc.)? Yes No If yes, provide explanation on supplemental pages. 12J. Have you ever drugged a person without their knowledge for a sexual purpose (i.e. roofie)? If yes, Yes No provide explanation on supplemental pages. 12K. Since you have been an adult (18 or older), have you ever had sexual contact with anyone under the age Yes No of 18? If yes, provide explanation on supplemental pages. Please use supplemental pages at the end of this questionnaire to provide additional information. Indicate item number & letter i.e.: 2B, 6C, 13C, etc.

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12L. As a juvenile (17 or younger), have you ever had sexual contact with anyone that was more than 2 years Yes No younger? If yes, provide explanation on supplemental pages. 12M. Have you ever shown any pornography to anyone 17 or younger (sexual material designed to arouse)? Yes No If yes, provide explanation on supplemental pages. 12N. Have you ever corresponded with a child for the purposes of luring them for any illegal or immoral Yes No reason? If yes, provide explanation on supplemental pages. 12O. Have you ever touched a child or had a child touch you for any sexual purpose? If yes, provide Yes No explanation on supplemental pages. 12P. Have you ever been accused of inappropriately touching a child? If yes, provide explanation on Yes No supplemental pages. 12Q. Have you ever searched for, viewed or possessed, for any reason, any image(s) of child pornography? If Yes No yes, provide explanation on supplemental pages. 12R. Have you ever had any sexual contact with any family member? If yes, provide explanation on Yes No supplemental pages. 12S. Have you ever engaged in sexual contact with a pet or any animal? If yes, provide explanation on Yes No supplemental pages. 12T. Have you ever searched for, viewed, or possessed, for any reason, any image(s) of bestiality (sexual Yes No contact between a person and an animal)? If yes, provide explanation on supplemental pages. 12U. Have you ever exposed yourself in public for a sexual purpose? If yes, provide explanation on Yes No supplemental pages. 12V. Did you ever look into anyone’s home or business windows to view someone for any sexual reason? If Yes No yes, provide explanation on supplemental pages. 12W. Have you ever filmed, recorded, or viewed anyone in an area where they had an expectation of privacy (bathroom, dressing room, bedroom, tanning salon, etc.)? If yes, provide explanation on supplemental Yes No pages. 12X. Have you ever engaged in a sex act in a public place (bathrooms, cars, parks, etc.)? If yes, provide Yes No explanation on supplemental pages. 12Y. Have you ever engaged in a sex act while in an adult oriented business (adult book stores, massage Yes No parlors, strip clubs, sex clubs, bath houses, etc.)? If yes, provide explanation on supplemental pages. 12Z. Have you ever participated in the filming or capture of any pornographic photos or videos? If yes, Yes No provide explanation on supplemental pages. 12AA. Have you ever been paid or received a benefit as a result of the filming or capturing of any Yes No pornographic photos or videos? If yes, provide explanation on supplemental pages. 12BB. Have you ever uploaded any pornography to the internet? If yes, provide explanation on supplemental Yes No pages. Sexually explicit means any photos or videos displaying any sex act.

12CC. Have you ever used an electronic device such as a cell phone or computer to transmit sexually explicit pictures or videos of yourself to someone else (i.e. Skype, Facetime, Snapchat, or anything using a webcam)? If yes, provide explanation on supplemental pages to include the following: • Total number of images/videos sent Yes No • Total number of incidents • Date when last incident occurred • Did the recipient request or want the images/videos • Age of the recipient

Please use supplemental pages at the end of this questionnaire to provide additional information. Indicate item number & letter i.e.: 2B, 6C, 13C, etc.

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12DD. Have you ever used an electronic device such as a cell phone or computer to transmit sexually explicit pictures or videos of someone else without their permission (i.e. Skype, Facetime, Google Friend Connect, Snapchat, or anything using a webcam)? If yes, provide explanation on supplemental pages to include the following: • Total number of images/videos sent Yes No • Total number of incidents • Date when last incident occurred • Did the recipient request or want the images/videos • Age of the recipient 12EE. Has anyone ever accused you of committing a sex crime? If yes, provide explanation on supplemental Yes No pages. 12FF. Have you committed any type of sex crime not already disclosed? If yes, provide explanation on Yes No supplemental pages.

13. COMPUTER CRIME/ISSUES 13A. Do you have any personal websites or web accounts (domain ownership/blogs)? If yes, provide Yes No explanation on supplemental pages. 13B. Is there any content on your website or social media accounts that could discredit yourself or the Scottsdale Police Department or the City of Scottsdale in any way? If yes, provide N/A Yes No explanation on supplemental pages. 13C. Have you ever sent an email that would be considered harassment, threatening, or otherwise illegal? If Yes No yes, provide explanation on supplemental pages. 13D. Have you ever committed or been present during the commission of computer hacking or any other Yes No computer crime? If yes, provide explanation on supplemental pages. 13E. Have you ever used or accessed chat rooms? If yes, provide explanation on supplemental pages to include the following: • Frequency of use Yes No • Type of chats rooms • Purpose for use/access 13F. Have you ever used or accessed peer-to-peer file sharing networks (i.e. BitTorrent, The Pirate Bay, Ares Galaxy, eMule, eDonkey, LimeWire, etc.)? If yes, provide explanation on supplemental pages to include the following: Yes No • Frequency of use • Type of peer-to-peer network • Purpose for use/access 13G. Have you ever used or accessed the dark web? If yes, follow directions listed in question 13J. Yes No 13H. Have you ever used the “Tor” anonymity network for communication such as messaging, software, or Yes No email? If yes, follow directions listed in question 13J. 13I. Have you ever purchased or used cryptocurrency? If yes, follow directions listed in question 13J. Yes No 13J. If you answered yes to question(s) 13G, 13H, or 13I, provide a full explanation for each question on supplemental pages to include the following: • Date first used, accessed, and/or purchased • Date last used, accessed, and/or purchased • Frequency of use • Purpose for use/access • Any other factors you believe are relevant

Please use supplemental pages at the end of this questionnaire to provide additional information. Indicate item number & letter i.e.: 2B, 6C, 13C, etc.

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14. DOMESTIC VIOLENCE Domestic violence (DV) refers to crimes committed between individuals with personal relationships such as former/current spouse, girlfriend/boyfriend, relative(s), individuals who live together in the same household (or who have lived together in the past); or individuals who have a child in common or are expecting a child (regardless of whether they have resided in the same household). The crimes include: • Assault • Criminal Damage • Endangerment • Imprisonment • Intimidation • Kidnapping • Trespass • Disorderly Conduct • Reckless display or discharge of a deadly weapon or dangerous instrument Verbal Abuse Emotional/Psychological Abuse Physical Abuse Repeated and excessive use of Systematic use of malicious manipulation through Intentional act causing injury or trauma language to humiliate or to undermine non-physical acts: harassment, intimidation, by way of bodily contact: hitting, dignity: name calling, mocking, breaking possessions, threatening to hurt others, pushing, shoving, striking, slapping, blaming, insulting, etc. confinement, isolation, etc. biting, kicking, pinching, punching, etc. 14A. Have you ever verbally demeaned, degraded or humiliated anyone with whom you have had a Yes No romantic or domestic relationship? If yes, provide explanation on supplemental pages. 14B. Have you ever broken anything or damaged any property belonging to yourself or another during a Yes No domestic dispute? If yes, provide explanation on supplemental pages. 14C. Have you ever confined, isolated or threatened to control or manipulate anyone with whom you have Yes No had a romantic or domestic relationship? If yes, provide explanation on supplemental pages. 14D. Have you ever intentionally or recklessly caused injury or trauma to anyone with whom you have had Yes No a romantic or domestic relationship? If yes, provide explanation on supplemental pages. 14E. Have you ever been in a physical altercation with someone whom you have had a romantic or Yes No domestic relationship? If yes, provide explanation on supplemental pages. 14F. Have you ever been in a physical altercation or disruptive verbal confrontation in a public place with someone whom you have had a romantic or domestic relationship? If yes, provide explanation on Yes No supplemental pages. 14G. Have you ever disciplined a child which resulted in injury or bruising? If yes, provide explanation on Yes No supplemental pages. 14H. Have you ever filed an order of protection, restraining order, or injunction against harassment Yes No against anyone? If yes, provide explanation on supplemental pages. 14I. Has anyone ever filed an order of protection, restraining order, or injunction against harassment Yes No against you? If yes, provide explanation on supplemental pages.

15. ORGANIZATIONAL MEMBERSHIP 15A. Are you now or have you ever been a member or supporter of any extremist organization that advocates or supports the use of force or fear to deny anyone their constitutional rights? If yes, Yes No provide explanation on supplemental pages. 15B. Have you ever been a member or supporter of any subversive, terrorist, supremacist, or militant Yes No group? If yes, provide explanation on supplemental pages. 15C. Have you ever been a member of a gang or attended a gathering of any gang? If yes, provide Yes No explanation on supplemental pages. 15D. Have you ever participated in any gang activity (i.e. graffiti/tagging/drive by shootings)? If yes, Yes No provide explanation on supplemental pages. 15E. Have you ever been a participant in a riot, illegal protest, illegal strike, or any similar illegal Yes No demonstration? If yes, provide explanation on supplemental pages. 15F. Have you ever done anything in your life for which you could be blackmailed or extorted? If yes, Yes No provide explanation on supplemental pages. Please use supplemental pages at the end of this questionnaire to provide additional information. Indicate item number & letter i.e.: 2B, 6C, 13C, etc.

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15G. Have you ever ridden with any known outlaw motorcycle groups? If yes, provide explanation on Yes No supplemental pages. 15H. Are you applying with the Scottsdale Police Department for any reason other than employment? If Yes No yes, provide explanation on supplemental pages.

16. GAMBLING 16A. Do you have a habit of gambling? If yes, provide explanation on supplemental pages. Yes No 16B. Have you ever been involved in any illegal gambling activities? If yes, provide explanation on Yes No supplemental pages. 16C. Have you ever worked for a gambling operation and/or booked any bets? If yes, provide explanation on Yes No supplemental pages. 16D. Do you now or have you ever had any gambling debts? If yes, provide explanation on supplemental Yes No pages. 16E. Have you ever used, taken, or borrowed, without permission, an employer’s money to gamble with Yes No including lottery/scratcher tickets? If yes, provide explanation on supplemental pages. 16F. Have you ever used a credit card for gambling? If yes, provide explanation on supplemental pages. Yes No

16G. Have you ever gambled for money on the internet? If yes, provide explanation on supplemental pages. Yes No 16H. Have you ever borrowed money to gamble with or to pay a gambling debt? If yes, provide explanation Yes No on supplemental pages.

17. CIVIL ACTIONS 17A. Have you ever had a court judgment rendered against you? If yes, provide explanation on supplemental Yes No pages. 17B. Do you presently have any civil actions pending against you? If yes, provide explanation on Yes No supplemental pages. 17C. Have you ever been sued for a financial matter? If yes, provide explanation on supplemental pages. Yes No 17D. Have you ever received an eviction notice for any reason? If yes, provide explanation on supplemental pages to include the following: • Date Yes No • Location • Circumstances

18. FINANCES 18A. Are you obligated to pay alimony, spousal maintenance, and/or child support? If yes, list below and use Yes No supplemental pages to list additional dockets. Docket Number Court Name and Address (Street, City, State, Zip)

Starting Date Amount of Payment Payments Sent To

18B. Have you ever been behind/late in making any support payments? If yes, provide explanation N/A Yes No on supplemental pages. 18C. Have your wages ever been garnished for any reason? If yes, provide explanation on supplemental pages. Yes No

Please use supplemental pages at the end of this questionnaire to provide additional information. Indicate item number & letter i.e.: 2B, 6C, 13C, etc.

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18D. Are you delinquent on any of your financial obligations (30 days or more past due)? If yes, list below. Yes No Months/Years Debt/Company Balance Amount of Payment Past Due

18E. Have you ever had any of your financial obligations turned over to a collection agency? If yes, list Yes No below. Date Debt/Company Amount Past Due Status

18F. Have you ever filed for bankruptcy? If yes, list below. Yes No Date Type of Bankruptcy Court Amount Status

18G. Have you ever had to voluntarily or involuntarily relinquish ownership of any home, business vehicle, and/or other property (i.e. repossession, foreclosure, short sale, or eviction due to financial issues, Yes No etc.)? If yes, list below and provide explanation on supplemental pages. Date Debt/Company Amount Past Due Status

18H. Are you currently in a foreclosure or short sale process at this time? If yes, provide explanation N/A Yes No on supplemental pages. Please use supplemental pages at the end of this questionnaire to provide additional information. Indicate item number & letter i.e.: 2B, 6C, 13C, etc.

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18I. Are you currently in negotiation or have plans to enter into a foreclosure or short sale of any home, business and/or other property in the future? If yes, provide explanation on supplemental N/A Yes No pages. 18J. Have you ever failed to file state or federal income taxes? If yes, provide explanation on supplemental Yes No pages. 18K. Have you ever provided false information on your taxes? If yes, provide explanation on supplemental Yes No pages. 18L. Do you have any unresolved or outstanding tax obligations? If yes, list below. Yes No Tax Year Amount of Payment Balance Status

18M. Have you ever obtained unemployment, welfare funds, or food stamps illegally? If yes, provide Yes No explanation on supplemental pages. 18N. Have you ever borrowed money and not paid it back, or refused to pay any bills? If yes, provide Yes No explanation on supplemental pages. 18O. Do you have any private debts (i.e. Loan sharks, title loan companies, pawn shops, etc.)? If yes, Yes No provide explanation on supplemental pages. 18P. Have you ever avoided paying rent or any lawful debts by moving? If yes, provide explanation on Yes No supplemental pages.

19. CURRENT OR PREVIOUS LAW ENFORCEMENT EXPERIENCE

19A. Complete the questions in this section if you have ever been employed by a law enforcement agency, in a paid N/A or non-paid position. If this section does not apply to you, please select “N/A” and skip to the next section.

19B. Indicate by checking the boxes below if you have any of the following law enforcement experience:

Police Officer Police Reserve Military Police Police Officer (Corrections Only) Detention/Corrections Civilian

19C. List any law enforcement academy training you have attended below:

Certification Certification Status Date Sponsoring Agency Academy Location & Hours (Current, Expired, Yes No Revoked, Etc.)

19D. List all assignments held. Include long term temporary duty assignments: Assignment Dates Agency Assignment Description of Job Duties Start End

Please use supplemental pages at the end of this questionnaire to provide additional information. Indicate item number & letter i.e.: 2B, 6C, 13C, etc.

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Continuation 19D: Assignment Dates Agency Assignment Description of Job Duties Start End

19E. List all advanced officer training you attended. Include specialty training and certifications: Hours Dates Location Type of Training Certified Completed

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

19F. List all law enforcement training as a civilian (non-sworn): N/A Hours Dates Location Type of Training Certified Completed

Yes No

Yes No

Yes No

Yes No

Yes No

Please use supplemental pages at the end of this questionnaire to provide additional information. Indicate item number & letter i.e.: 2B, 6C, 13C, etc.

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19G. Have you ever had a citizen’s complaint, criminal complaint, professional standards review, or internal investigation filed or submitted against you? If yes, list below and provide explanation on Yes No supplemental pages. Date Charge Disposition

19H. Have you ever accepted any unauthorized gratuities? If yes, provide explanation on supplemental pages. Yes No 19I. Have you ever been offered, solicited, or accepted a bribe or a payoff? If yes, provide explanation on Yes No supplemental pages. 19J. Have you ever accessed any confidential information for personal reasons or released any confidential Yes No information to any unauthorized person? If yes, provide explanation on supplemental pages. 19K. Have you ever perjured yourself in court or during any hearings to include discipline boards, internal Yes No investigation, MVD hearings, etc.? If yes, provide explanation on supplemental pages. 19L. Have you ever falsified any official report to include case reports, daily activity sheets, time sheets, Yes No and logs? If yes, provide explanation on supplemental pages. 19M. Have you ever falsified any evidence? If yes, provide explanation on supplemental pages. Yes No 19N. Have you ever taken/kept any property or money that was lost, stolen or belonged to an arrestee or an Yes No inmate for personal gain? If yes, provide explanation on supplemental pages. 19O. Have you ever taken/kept lost or stolen property that by policy should have been impounded? If yes, Yes No provide explanation on supplemental pages. 19P. Have you ever knowingly carried contraband into any custodial facility? If yes, provide explanation on Yes No supplemental pages. 19Q. Have you ever sold or given any contraband to any jail/prison inmate? If yes, provide explanation on Yes No supplemental pages. 19R. Have you ever had any contact with an arrestee, an inmate or their family members for personal or Yes No social purposes? If yes, provide explanation on supplemental pages. 19S. Have you ever had an unsatisfactory rating as a law enforcement employee, excluding during your training academy, field training, or probationary period? If yes, provide explanation on supplemental Yes No pages. 19T. Have you ever failed to qualify for any mandatory law enforcement ability testing? If yes, provide Yes No explanation on supplemental pages. 19U. Have you ever damaged departmental property and failed to report it? If yes, provide explanation on Yes No supplemental pages. 19V. During the time you were employed in a law enforcement capacity, did you ever use, inhale, ingest or inject any illegal drugs? This includes on-duty or off-duty. If yes, provide explanation on supplemental Yes No pages. Please use supplemental pages at the end of this questionnaire to provide additional information. Indicate item number & letter i.e.: 2B, 6C, 13C, etc.

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19W. During the time you were employed in a law enforcement capacity, did you ever consume alcohol or illegal drugs at any official or unofficial work location? This includes on-duty or off-duty. If yes, Yes No provide explanation on supplemental pages.

19X. During the time you were employed in a law enforcement capacity, did you ever engage in any sexual act, either alone or with another individual, at any official or unofficial work location? This includes Yes No on-duty or off-duty. If yes, provide explanation on supplemental pages. 19Y. Have you ever done anything off-duty that by policy should have been reported or was reported to Yes No your agency (i.e. DUI, DV)? If yes, provide explanation on supplemental pages. 19Z. Have you ever used or been accused of using excessive force? If yes, provide explanation on Yes No supplemental pages. 19AA. Have you ever accidentally discharged any weapon to include any non-lethal weapons such as Taser Yes No and/or bean bag? This includes on-duty or off-duty. If yes, provide explanation on supplemental pages. 19BB. Have your ever intentionally discharged your weapon in the course of your duties excluding training Yes No purposes? This includes on-duty or off-duty. If yes, provide explanation on supplemental pages.

19CC. Have you ever taken police action while off duty? If yes, provide explanation on supplemental pages. Yes No

20. MILITARY SERVICE 20A. Have you ever applied to any of the armed forces and been denied? If yes, provide explanation on Yes No supplemental pages. 20B. Complete the questions in this section if you have ever served in the Army, Navy, Marine Corps, Air Force, Coast Guard, R.O.T.C. (including Reserves or National Guard) or any other military or semi- N/A military organization. If this section does not apply to you, please select “N/A” and skip to the next section. 20C. List all areas of military service:

Branch / Organization Entry Date Separation Date Rank / Rate Discharge Type

20D. Did you receive an honorable discharge? If no, provide explanation on supplemental pages. Yes No 20E. Were you ever the subject of any military investigation? If yes, provide explanation on supplemental Yes No pages. 20F. Have you ever received any of the following discipline during your military service? If yes, indicate below and provide explanation on supplemental pages.

Verbal Reprimand Written Reprimand Reduction In Rank Reduction In Pay Restricted/Suspended Privileges Other 20G. Have you ever held any type of military/federal government security clearance? If yes, list below. Yes No

Date Type Status

Please use supplemental pages at the end of this questionnaire to provide additional information. Indicate item number & letter i.e.: 2B, 6C, 13C, etc.

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If yes, provide 20H. Have you ever had your military/federal government security clearance canceled or revoked? Yes No explanation on supplemental pages. 20I. Have you ever provided any classified, secret, or top-secret information to any unauthorized person? If Yes No yes, provide explanation on supplemental pages. 20J. While in the service were you ever on unauthorized absence or AWOL? If yes, provide explanation on Yes No supplemental pages. 20K. Were there any special circumstances that caused you to leave the military prior to the end of your contracted tour of service (i.e. intentional acts to get out early, poor evaluations, inability to promote, Yes No hardship, continued education, etc.) If yes, provide explanation on supplemental pages. 20L. Have you ever been involved in the theft, misuse, re-appropriation of any U.S. Government Yes No equipment? If yes, provide explanation on supplemental pages. 20M. Have you ever been in possession of any prohibited article? If yes, provide explanation on supplemental Yes No pages. 20N. Did you participate in any imminent danger assignments/deployments? If yes, provide explanation on Yes No supplemental pages. 20O. Have you ever participated in or witnessed any activity that would be against military protocol? If Yes No yes, provide explanation on supplemental pages. 20P. Have you ever killed or seriously injured anyone during military action? If yes, provide explanation on Yes No supplemental pages. 20Q. Have you ever been involved in or witnessed any friendly fire incidents? If yes, provide explanation on Yes No supplemental pages. 20R. Did you successfully complete all required training? If yes, provide explanation on supplemental pages. Yes No 20S. Are you eligible to re-enter the United States Armed Forces? If yes, provide explanation on supplemental Yes No pages.

21. SUPPLEMENTAL PAGES Item Number Explanation

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Item Number Explanation

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Item Number Explanation

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Item Number Explanation

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APPLICANT - READ STATEMENT AND HAVE NOTARIZED

I hereby certify that all answers to questions on this Background Questionnaire are true and complete. I further understand and agree that any falsification of information or material, any non-disclosure of information or any misrepresentation or deception may cause forfeiture on my part of all rights to any consideration for employment with the City of Scottsdale.

______Signature of Applicant Date

Signature of Applicant: ______Date:

______

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.

Signature of Notary Public: ______

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15. RELEASE OF LIABILITY WAIVER

AUTHORIZATION FOR RELEASE OF INFORMATION

The below named individual has applied for a position of trust with the Scottsdale Arizona Police Department. He/She has listed you and/or your organization as an employer, personal reference or a jurisdiction where they have lived/worked or have had contact with on their background packet. Please complete the attached questionnaire and return it in a timely manner to the Scottsdale Police Department Personnel Unit. All responses are confidential. Your cooperation is greatly appreciated.

I, ______, DO HEREBY AUTHORIZE any and all persons, partnerships, corporations, and all civilian and government entities, military agencies, law enforcement agencies, private, City, County, State, Tribal, and Federal entities to release, furnish and exchange, any and all available information relating to me for the purpose of determining my suitability for law enforcement employment. This includes, but is not limited to, all information related to my employment, performance, disciplinary history, character, integrity, reputation, conduct, behavior, background and polygraph information. (This authorizes release of this information to the Scottsdale Police Department.) This release is in addition to, and not intended to curtail or diminish the authorization and immunity provided by statute. I DO HEREBY RELEASE from any and all liability all persons or entities disclosing information pursuant to this release.

______Full Name Former Names

______Date of Birth Last 4 digits of Social Security Number

______Address City State Zip Code

(_____)______Telephone Number Email Address

Signature of Applicant: ______Date: ______

APPLICANT - READ AND COMPLETE ABOVE WAIVER AND HAVE NOTARIZED

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.

Signature of Notary Public: ______

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FOR CANDIDATE’S USE

CHECK-OFF LIST OF ITEMS REQUIRED TO SUBMIT ALONG WITH THIS COMPLETED BACKGROUND QUESTIONNAIRE:

AZPOST Personal History Form (Police Officer Applicants ONLY)

Credit Report (Must be from one of the major credit bureaus: Experian, Equifax or TransUnion) – Current (within the past 90 days) – Complete Credit History is Required not Credit Summary. Credit Score does not need to be included.

Memorandum: Intent and Interest in the position applied for.

Memorandum: What you have done to prepare for the position.

Memorandum: Your current fitness regimen/routine including running distance and time. (Police Officer Applicants ONLY)

If you have questions, contact the Personnel Unit at 480-312-1933 or [email protected].

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FOR CANDIDATE’S USE

CHECK-OFF LIST OF ITEMS REQUIRED TO BRING WITH YOU TO YOUR BACKGROUND INTERVIEW, ONLY IF SELECTED TO MEET IN-PERSON WITH A BACKGROUND INVESTIGATOR:

(Do NOT submit these documents with your background packet)

Birth Certificate Original (Bureau of Vital Statistics copy)

Naturalization / Right to Work Papers Original (if applicable)

Passport – Current and Expired Original (if applicable)

Social Security Card Original

Driver’s License / State Identification Card Original

Military Discharge - DD214, page 4 Original (if applicable)

Other Military Paperwork (if applicable)

Name Change Documents Original (if applicable)

Marriage Certificate(s) (if applicable)

Divorce Decree(s) (if applicable)

High School Transcript(s) Original & Sealed

College Transcript(s) Original &Sealed (if applicable)

Bankruptcy Paperwork (if applicable) If you have current or prior Law Enforcement employment (sworn) bring copies of your training file, including hours of basic, advanced and in-service training with curriculum, hours and all related certificates. Other items:

If you have questions, contact the Personnel Unit at 480-312-1933 or [email protected].

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