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Personal Reference Verification Questionnaire

  1. Are you related to the applicant? (This includes being a relative through marriage)?*

  2. (Years)

  3. (Neighbor, friend, co-worker, etc…)

  4. Do you consider the applicant trustworthy with confidential information?*

  5. Would you say the applicant is dependable?*

  6. To your knowledge, has the applicant ever exhibited extreme nervousness or loss of temper (to include domestic disputes)?*

  7. Are you aware of any circumstances which might disqualify the applicant for public service?*

  8. Are you aware of any current illegal substance abuse (alcohol and/or drug use) by the applicant? *

  9. Have you seen the applicant display bias or prejudice toward any racial, ethnic, or religious groups?*

  10. Leave This Blank:

  11. This field is not part of the form submission.