DALLAS AREA RAPID TRANSIT POLICE DEPARTMENT

1 DALLAS area RAPID TRANSIT POLICE DEPARTMENT APPLICATION SUPPLEMENT Page 1 of 14 PERSONAL INFORMATION Name _____ LAST FIRST MIDDLE MAIDEN SUFFIX Alias(es) / Nickname(s) / Other name(s) by which you are/have been known: Name: Date(s) when used - Name: Date(s) when used - If additional space is needed, use page 13. Are you using page 13 to supplement this section? Yes No _____ _____ _____ CELL PHONE HOME PHONE EMAIL ADDRESS Social Security #_____ Are you a United States citizen?

2 Yes No Date of Birth _____ Place of Birth _____ MONTH DAY YEAR CITY COUNTY STATE Have you ever taken a polygraph examination? Yes No If "Yes," complete the following: Date For whom Results (passed, failed, inconclusive, etc.) _____ _____ _____ _____ _____ _____ If additional space is needed, use page 13. Are you using page 13 to supplement this section? Yes No Have you ever been fingerprinted? Yes No If "Yes", complete the following: Date Agency Purpose (arrest, job application, etc.) _____ _____ _____ _____ _____ _____ _____ _____ _____ If additional space is needed, use page 13. Are you using page 13 to supplement this section?

3 Yes No DRUG USAGE List all of your drug use below (to include any ingestion into your body by any means, such as experimenting, trying, inhaling, injecting, smoking, swallowing, snorting, etc.): Type of Drug Ever used or possessed? # of uses or possessions Date First Used Date Last Used Ever delivered, sold, grown, or manu-factured? # of times delivered, sold, grown, or manu-actured Date first delivered, sold, grown, or manu-actured Date last delivered, sold, grown, or manu-actured Marijuana (less than 4 ounces) Yes No Yes No Marijuana (more than 4 ounces) Yes No Yes No Hashish, Hashish Oil, THC Yes No Yes No Cocaine (crack, coke) Yes No Yes No Heroin (cheese, black tar, etc.) Yes No Yes No Opium/Morphine Yes No Yes No Meth/Amphetamines (crystal meth, uppers, ecstasy, XTC, speed, crank) Yes No Yes No PCP (angel dust) Yes No Yes No Hallucinogens (LSD, acid, peyote, mescaline, psilocybin, mushrooms) Yes No Yes No Barbiturates/Quaaludes/ Benzodiazepines (Xanax, Valium, downers, Rohypnol, GHB, roofies, 4 bars) Yes No Yes No Inhalents (chemicals, paint, glue, etc.)

4 Yes No Yes No Steroids Yes No Yes No Prescription medication not prescribed to you _____ Yes No Yes No Prescription medication not prescribed to you _____ Yes No Yes No Other _____ Yes No Yes No Other _____ Yes No Yes No If additional space is needed, use page 13. Are you using page 13 to supplement this section? Yes No DALLAS area RAPID TRANSIT POLICE DEPARTMENT APPLICATION SUPPLEMENT Page 2 of 14 RESIDENTIAL INFORMATION List all addresses where you have lived for the past ten (10) years in chronological order, beginning with your present address. Provide full address, including apartment complex name and number and zip code. Also include duty station if in the military and/or dormitories when in college. FROM MO YR TO MO YR ADDRESS STREET NUMBER CITY COUNTY STATE ZIP _____ _____ _____ House-Own House-Rent Apartment Dorm Military Base _____ LANDLORD S NAME OR APARTMENT COMPLEX NAME PHONE # _____ _____ _____ House-Own House-Rent Apartment Dorm Military Base _____ LANDLORD S NAME OR APARTMENT COMPLEX NAME PHONE # _____ _____ _____ House-Own House-Rent Apartment Dorm Military Base _____ LANDLORD S NAME OR APARTMENT COMPLEX NAME

5 PHONE # _____ _____ _____ House-Own House-Rent Apartment Dorm Military Base _____ LANDLORD S NAME OR APARTMENT COMPLEX NAME PHONE # _____ _____ _____ House-Own House-Rent Apartment Dorm Military Base _____ LANDLORD S NAME OR APARTMENT COMPLEX NAME PHONE # _____ _____ _____ House-Own House-Rent Apartment Dorm Military Base _____ LANDLORD S NAME OR APARTMENT COMPLEX NAME PHONE # _____ _____ _____ House-Own House-Rent Apartment Dorm Military Base _____ LANDLORD S NAME OR APARTMENT COMPLEX NAME PHONE # _____ _____ _____ House-Own House-Rent Apartment Dorm Military Base _____ LANDLORD S NAME OR APARTMENT COMPLEX NAME PHONE # _____ _____ _____ House-Own House-Rent Apartment Dorm Military Base _____ LANDLORD S NAME OR APARTMENT COMPLEX NAME PHONE # Have you ever been evicted or asked to leave a residence?

6 Yes No Have you ever left a residence owing rent? Yes No If you answered yes to either of the above questions, explain in detail. If additional space is needed, use page 13. Are you using page 13 to supplement this section? Yes No DALLAS area RAPID TRANSIT POLICE DEPARTMENT APPLICATION SUPPLEMENT Page 3 of 14 EDUCATION List ALL High Schools you attended in chronological order, starting with the most recent: Name of School attended City & State Dates Attended Graduated From To _____ _____ _____ _____ Yes No _____ _____ _____ _____ Yes No If additional space is needed, use page 13. Are you using page 13 to supplement this section? Yes No If you have a , date issued: _____ issued by: _____ Have you ever been expelled or suspended from any school, college, or university? Yes No If yes, explain in detail: List ALL Colleges/Universities you have attended in chronological order, starting with the most recent: College / University Attendance Dates Completed Credit Hours Degree(s) (mark all that apply) _____ ____-____ _____ NONE ASSOCIATES BACHELORS MASTERS DOCTORATE OTHER _____ ____-____ _____ NONE ASSOCIATES BACHELORS MASTERS DOCTORATE OTHER _____ ____-____ _____ NONE ASSOCIATES BACHELORS MASTERS DOCTORATE OTHER If additional space is needed, use page 13.

7 Are you using page 13 to supplement this section? Yes No DRIVING RECORD List all driver s licenses you have ever been issued: Driver s License # State Date issued Active? Yes No Yes No Yes No If additional space is needed, use page 13. Are you using page 13 to supplement this section? Yes No List ALL traffic citations you have received in the last 10 years, excluding parking citations: Month & Year Charge / Violation City & State Disposition (fine, not guilty, etc.) _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ If additional space is needed, use page 13. Are you using page 13 to supplement this section? Yes No Describe ALL traffic accidents in which you have been involved as the driver in the last 10 years: 1. Date _____ Location _____ POLICE Report: Yes No Description _____ 2.

8 Date _____ Location _____ POLICE Report: Yes No Description _____ If additional space is needed, use page 13. Are you using page 13 to supplement this section? Yes No Has your driver's license issuance (or renewal) ever been denied? Yes No Has your driver's license (or privilege) ever been suspended or revoked? Yes No Has a traffic citation ever resulted in a warrant for your arrest? Yes No Have you ever driven a vehicle without auto insurance, as required by law? Yes No If you answered yes to any of the above questions, explain in detail. If additional space is needed, use page 13. Are you using page 13 to supplement this section? Yes No DALLAS area RAPID TRANSIT POLICE DEPARTMENT APPLICATION SUPPLEMENT Page 4 of 14 MILITARY RECORD Have you ever been refused entry into the United States Armed Forces?

9 Yes No If yes, explain in detail: _____ Have you served in the United States Armed Forces? Yes No **ONLY COMPLETE THE REMAINDER OF THIS SECTION IF YOU HAVE SERVED IN THE MILITARY** Branch of Service _____ Dates of Service: from _____ to _____ Highest Rank Held _____ Type of Discharge _____ Rank when Discharged _____ Name of Last Commanding Officer _____ Are you eligible for re-enlistment? Yes No If no, give complete details: _____ _____ Were you ever denied a security clearance, or had a clearance revoked, suspended, or downgraded, either military or any other federal, state, or municipal clearance? Yes No Have you ever been the subject of any judicial or non-judicial disciplinary action while in the military (including court martial, captain's mast, office hours, company punishment, etc.)

10 ? Yes No If you answered yes to either of the above questions, explain in detail. If additional space is needed, use page 13. Are you using page 13 to supplement this section? Yes No EMPLOYMENT RECORD Are you eligible for rehire at all of your previous employers? Yes No If no, explain in detail. If additional space is needed, use page 13. Are you using page 13 to supplement this section? Yes No In your employment history, have you ever: been investigated for misconduct or been the subject of a complaint? Yes No received written or documented counseling? Yes No been issued a written reprimand? Yes No been demoted or received a reduction in rank? Yes No been suspended? Yes No been terminated from a job? Yes No received any other form of disciplinary or corrective action?