Contractor_Pre-Employment_form.rtf

CONTRACTOR PRE-EMPLOYMENT FORM

NAME

ADDRESS

E-MAIL ADDRESS

Do you know or are you related to anyone who is currently an inmate in this or any other correctional institution?

Yes No

If yes, please provide names, locations, relationships and describe any current or anticipated contact with the inmate(s).

Are there any criminal charges currently pending against you?

Yes No

If so, please provide charge, date arrested, court dates, docket numbers and any other pertinent details.

Are you now or have you ever been incarcerated or under correctional supervision (including home detention, probation, work release, etc.)?

Yes No

If so, please provide dates of incarceration, sentence, location, charges, current status and any other pertinent details.

CERTIFICATION -- I certify that all of the statements made on these pages are true, complete and correct to the best of my knowledge and belief and are made in good faith.

Signature (sign in ink) Date