PRE-EMPLOYMENT QUESTIONS POLYGRAPH EXAMINATION
Please complete with application.
GENERAL QUESTIONS:
1. Have you told me your correct name?
YES
NO
2. Have you told me your correct age?
YES
NO
3. Have you ever had a polygraph test before?
YES
NO
4. Have you taken any drugs or medicine today?
YES
NO
5. Have you been truthful about your military record?
YES
NO
6. Are you eligible to work in the United States?
YES
NO
7. Have you been truthful about your education?
YES
NO
8. Do you live at the address listed on this application?
YES
NO
9. Do you ever drink on the job?
YES
NO
RESPONSIBILITY AND STABILITY QUESTIONS:
10. Do you feel qualified for this job?
YES
NO
11. Are you seeking permanent employment?
YES
NO
12. Have you ever been fired for dishonesty?
YES
NO
13. Have you ever quit a job without required notice?
YES
NO
14. Have you falsified any part of your application?
YES
NO
15. Have you told the truth about your employment?
YES
NO
16. Did you deliberately leave any employer off your application?
YES
NO
17. Do you want this job for any reason other than employment?
YES
NO
DRIVING RECORD:
18. Has your driver's license ever been suspended?
YES
NO
19. Have you been truthful about your driving record?
YES
NO
20. Have you ever had a vehicle accident?
YES
NO
21. Have you ever had a commercial vehicle accident?
YES
NO
SECURITY QUESTIONS:
22. Have you ever tried or used narcotics, drugs or marijuana illegally?
YES
NO
23. Have you knowingly cashed a bad check?
YES
NO
24. Did you ever forge a check?
YES
NO
25. Did you ever steal merchandise or materials from an employer?
YES
NO
26. Did you ever steal money from your employer?
YES
NO
27. Did you ever participate in a theft ring?
YES
NO
28. Did you ever commit a serious, undetected crime?
YES
NO
29. Are you wanted by a law enforcement agency?
YES
NO
30. Have you ever been arrested?
YES
NO
31. Have you ever been in jail or prison?
YES
NO
32. Have you ever been refused by a bonding company?
YES
NO
33. Are you now on probation or parole?
YES
NO
34. Have you ever been involved in a criminal offense?
YES
NO
35. Have you ever committed any act that would leave you for pressure or blackmail?
YES
NO
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