• Personal History Questionnaire

  • As an applicant for a position with the Raytown Police Department, you are required to complete this Personal History Questionnaire. Any false statement or omission on this questionnaire will cause your name to be removed from the eligibility list, or be considered for immediate dismissal if an appointment is made. Do you understand this statement?*

  • ANY QUESTIONS ANSWERED “YES” REQUIRE A DETAILED EXPLANATION.

    A “Yes” answer may not, in and of itself, be grounds for disqualification or non-selection, whereas an untruthful response will be.

    Prior to selecting "Next" on each of the following pages, please ensure that all the answers are correct and the explinations are complete. You will NOT have the ability to go back and change answers once the page has been completed.

  • Personal History

  • Are you known by or have you ever used any other names, monikers or aliases?*
  • Have you ever been found to be untruthful during a lie detector test?*
  • Have you ever been disqualified for employment by any law enforcement agency including this department? If so, what department(s)?*
  • Have you ever been named in or violated a restraining order or an order of protection?*
  • Have you ever consumed alcoholic beverages during work hours knowing it was against policy or rules?      *
  • Have you ever belonged to or associated with a subversive or militant group,alliance or organization that advocates racism or hatred toward others because of their way of life, background, culture or customs, or United States, or state or city governments?*
  • Have you ever run from any police officer, resisted arrest or fought with a police officer or law enforcement official?*
  • Have you ever brandished, fired or pointed a firearm in a threatening, rude, angry manner to scare, harm or intimidate someone?*
  • Have you ever been a gang member or associated with gang members?*
  • Have you ever stolen or attempted to steal anything at any time, to include shoplifting or the switching of price tags?*
  • Have you ever entered a house, garage, building or other dwelling to commit a theft?*
  • Have you ever used a weapon, applied force or fear to steal something from someone?*
  • Have you ever been charged with a felony, or misdemeanor including where the conviction was reduced to a lesser crime*
  • Have you ever caused an injury or death to someone as a result of your driving?*
  • Have you ever been told by your spouse or anyone else that you drink too much or have problems related to alcohol?*
  • Are you currently living or ever lived, with a convicted felon, someone who is on parole from prison, has committed or is committing crimes?*
  • Have you ever used the Internet to view, purchase, sell or participate in child pornography or animated child porn?*
  • Have you ever given a friend, relative or other unauthorized person restricted or confidential information that you obtained and knew was against employment regulations or federal or state laws?*
  • Have you ever used or solicited the services of a prostitute, or ever committed prostitution or obtained any financial support soliciting prostitution?*
  • Have you ever used any type of drug or narcotic or any type of intoxicating chemical to seduce or overpower someone to have sex with you knowing it was without their permission*
  • Since the age of 18 have you ever had sex with someone under the age of 18 or who you suspected or claimed to be under the age of 18?*
  • Have you ever forced or attempted to force a person to have sex with you?*
  • Have you ever had sexual contact with a child (fondling, taking pornographic pictures, masturbating in a child’s presence, oral sex, sexual intercourse, etc)?*
  • Have you ever been labeled as or had to register as a sex offender?*
  • Have you ever looked into any window or opening to invade someone’s privacy?*
  • Have you ever intentionally started a fire to cause property damage or to injure someone else?*
  • Have you ever tormented, mistreated, neglected, abused, tortured, maimed, beaten or brutally killed an animal or a pet?*
  • Have you ever illegally damaged or destroyed property or committed any acts of malicious mischief which resulted in property damage?*
  • Have you ever filed or declared bankruptcy, had your wages garnished, or had a debt, account or loan turned over to a collection agency? *
  • Have you ever obtained and/or used a credit card, ATM card, debit card or check card illegally?*
  • Have you ever skipped out on paying a loan or avoided paying any debt by moving away, changing your name or Social Security number?   *
  • Have you ever attempted or obtained financial gain through dishonest means or illegal acts, to include illegal gambling?*
  • Are you afraid of physical combat?*
  • Will any teacher or other school official tell us you had behavioral problems such as fighting or threatening any teachers or school officials? *
  • Have you ever withdrawn, waived or discontinued your application to a law enforcement agency because you knew or suspected that you were going to be non-selected or disqualified after you applied?*
  • Have you ever failed or dropped out of any law enforcement academy or training class?*
  • Have you ever stolen money, property, equipment or material from any employer or kept pay you did not earn by fabricating or misrepresenting work hours or overtime ?*
  • Have you ever been found to be in violation of any law, regulation or work policy involving, discrimination, sexual harassment or workplace violence or ever done anything improper that if caught you would be fired or suspended?*
  • Have you ever been disciplined, suspended or fired for losing your temper, being untruthful?*
  • Have you ever engaged in, participated in or not reported acts of racism or discrimination towards any employee?*
  • Have you ever been charged, arrested, detained or placed on any court ordered probation In the United States or in any other country?*
  • Have you ever assaulted or threatened violence to another person including a spouse or significant other?*
  • Have you ever followed someone against their will, or stalked someone by following them secretly via social media or any electronic communication (stranger, someone you know, public figure or entertainer)?*
  • Have you ever intentionally given false information to a court official, city attorney, district attorney, judge,police officer or any other law enforcement officer or filed a false police report or called in a false emergency?*
  • Have you ever injured or been accused of injuring a child as a result of losing your temper or using corporal  punishment?*
  • Have you ever been involved in a physical fight with someone? (including school yard fights or any physical fight required by previous employment)*
  • Have you ever failed to appear in court regarding a traffic citation you received?*
  • Have you ever been refused or has your driver’s license ever been suspended or revoked from any state*
  • Have you ever drove off or fled the scene of a traffic accident or collision?*
  • Have you ever driven on a suspended, revoked or invalid driver’s license?*
  • Have you ever driven or been arrested for driving while under the influence of an alcoholic beverage or narcotic?*
  • Have you ever committed a dishonest or immoral act to obtain a job, promotion, transfer, or higher performance rating?*
  • Have you ever made a false allegation or false complaint against a supervisor, manager or  coworker?*
  • Have you ever filed a false or fictitious work injury report or filed a false workers compensation claim?*
  • Have you ever called in sick to work when you were really well? (i.e. not enough time to request the day off, hungover, other job application process)*
  • Have you ever committed a hate crime even if not caught?*
  • Have you ever been taken to a jail or a police holding room?*
  • Have you ever pretended to be a law enforcement officer with the intent of misleading someone in order to obtain personal information or confidential information or in order to detain, confine, restrict, arrest or scare someone*
  • Have you ever left or abandoned a child or children without proper care or supervision?*
  • Have you ever violated a child custody order?*
  • Have you ever fired a firearm at a house, building, apartment, vehicle, vessel or aircraft?*
  • Have you ever purchased, constructed, or attempted to construct a bomb or explosive, or associated with someone who has?*
  • Have you ever been in a vehicle when someone else discharged a firearm?*
  • Have you ever filed or reported a false auto insurance claim?*
  • Have you ever been involved in a fight, altercation, confrontation, argument or exchange of hand gestures with another motorist while driving?*
  • Have you ever purchased alcohol for minors, purchased alcohol while under the legal age to purchase alcohol or used a fictitious/ forged identification or used another person’s identification to purchase alcohol?*
  • Have you ever consumed alcoholic beverages as a passenger or driver of a vehicle?*
  • Have you ever allowed someone to keep, store or hide stolen property at your home or property?*
  • Have you ever allowed someone running from the police or other authorities to stay at your residence including juvenile runaways and wanted persons?*
  • Has a law enforcement officer visited your home for the purpose of investigating a crime, or to ask you or any member of your household questions about a crime?*
  • Have you ever used a computer to obtain illegal, unlawful, unauthorized, or prohibited information for you or someone else or to sell it for profit?*
  • Have you ever sent racist or sexual discrimination information via email, fax, text, pager or another electronic device?*
  • Have you ever illegally exposed yourself (genitals) to anyone?*
  • Have you ever participated in any sexual act or been aroused, related to having sex with an animal?*
  • Have you ever had to borrow money or had any family or employment problems due to gambling?*
  • Have you ever been delinquent or late on paying income taxes or other taxes?*
  • Have you ever intentionally written a bad check?*
  • Have you ever filed a fictitious, false, or untrue tax return?*
  • Have you ever collected unemployment benefits, welfare, or government aid that you were not entitled to or through dishonest means or filed a false claim?*
  • Have you ever used a false or different social security number for any reason?*
  • Are there any civil actions in civil court in which you have been or currently involved?*
  • Have you ever had your conviction records sealed or expunged?*
  • Are you concerned about using a firearm?*
  • Have you ever had your vehicle searched?*
  • Have you ever altered, falsified, counterfeited or forged any school record, application or transcript?*
  • Have you ever taken a concealed firearm or weapon to any public/private school or on any college campus?*
  • Have you ever assisted someone to escape from police custody, detention or jail?*
  • Have you ever covered up a crime or mislead any public official?*
  • Do you currently have or have you ever had any tattoos or monikers that are gang related, offensive, or visible when wearing a long sleeve shirt?*
  • Have you ever committed any graffiti, tagging or similar act?  *
  • Have you ever been involved in a speed contest or road race on a public roadway?  *
  • Have you ever been refused alcohol or asked to leave an establishment because of your alcohol consumption?*
  • Have you ever done anything illegal after alcohol consumption?*
  • Have you ever been threatened with eviction or been evicted?*
  • Have you intentionally omitted any adverse information or facts in any of the information you have provided during this employment process?*
  • Is there anything that you have not been asked that could be considered negative or adverse and might eliminate you from consideration of employment with the Raytown Police Department?*
  • Have you ever applied to a law enforcement or government agency, including Raytown Police Dept.? If yes, when and where?*

  • Drugs

  • Have you ever been given or sold, marijuana or any other type of illegal substance, chemical,drug or narcotic to anyone and if so when? *
  • Have you ever cultivated grown or purchased marijuana?*
  • Have you allowed someone to use marijuana, illegal drugs, narcotics, or any illegal substance in your home or vehicle?                   *
  • Have you ever taken any prescription drugs that were not prescribed to you by a doctor?*
  • Have you ever tested positive on any drug test (employment or other)?*
  • Have you ever manufactured any illegal drug, narcotic, designer drug or illegal substance or chemical?*
  • Have you ever purchased or been involved in an illegal drug transaction,or transportation of illegal drugs? *
  • Have you ever sold or provided any chemical compound or element to someone, knowing the purpose was to manufacture an illegal substance, designer drug, narcotic, or similar product?*
  • Have you ever attempted to obtain a prescription drug or narcotic knowing the prescription was forged?*
  • Have you ever sold any prescription drug for any reason?*
  • Are there any illegal drugs, narcotics, or paraphernalia in your home, vehicle or property associated to you (even though they may belong to someone else)?*
  • Rows

  • Peace Officer Questions

  • Have you ever been a peace officer, reserve peace officer, or military police officer?*

  • Those applicants who are now or have previously been a peace officer, reserve peace officer, or military police officer must answer the remainder of the questions.
  • As a peace officer, have you ever accepted a gratuity?
  • As a peace officer, have you ever accepted anything for overlooking a violation?
  • As a peace officer, have you ever made a false official report?
  • As a peace officer, have you ever used your position for personal gain?          
  • As a peace officer, have you ever withheld evidence seized in the course of your official duties?           
  • As a peace officer, have you ever had sex while on duty? 
  • Have you ever been the subject of an internal affairs investigation?
  • Have you ever had a citizen complaint alleged against you?
  • Have you ever had any disciplinary actions taken against you, including suspensions, written or oral reprimands?                                               
  • Have you ever been involved in an incident where it was necessary to use deadly force, regardless whether the person died or not.
  • Have you ever been involved in any relationship with a prisoner, inmate, or detainee in or out of custody?                                                                                                                                 

  • By clicking the "submit" button below I hereby certify that all statements made in this application are true and complete. I understand that any misstatements of material facts will subject me to disqualification or dismissal.

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