Relationship Questionnaire- Your responses are protected by law and will never be shared with the applicant.
Your Phone Number
Your E-mail address
Type of Relationship:
Former Intimate Partner
Registered Domestic Partner
Former Registered Domestic Partner
Significant other (over 3 months)
Former significant other
Dates of relationship:
Exp: 5/2000 to 9/2009
How and where did you meet? How long have you known the applicant?
Has the applicant ever been physically or mentally abusive to you, such as yelling, berating, hitting, pushing, slapping, shoving or threatening to harm you in any manner?
How does the applicant handle adversity, stressful or frustrating situations?
Have you ever known the applicant to act in an impulsive or reckless manner?
Are they a responsible driver?
Have you ever observed the applicant display any bias or prejudices toward anyone?
How does the applicant interact with people in general?
Exp: Hard to get to know, standoffish, friendly and personable.
How would you describe the applicant’s verbal and writing skills in English?
How would you describe the applicant’s judgment and decision making skills?
Are you aware of any history of employment problems?
How does the applicant manage personal finances? Do/Did they work well with you in financial decisions, or do they hide the fact they have purchased items, or gambled?
Have you ever observed or suspected the applicant was committing any drug and or alcohol related crime?
I.E., Drunk driving, drunk in public, behavior changes due to alcohol or drug use.
Do you have any knowledge of the applicant abusing drugs and/or prescription medications?
Are you aware of the applicant having any negative contact with law enforcement?
Other than minor traffic violations.
Have you ever questioned the applicant’s honesty or integrity?
What areas of the applicant's life do you think could improve?
Relationships, education, employment, etc.
Do you support the applicant’s desire to work in Public Safety?
Is there anything we did not ask that you think is important to note?
Do you know anyone else who might be able to provide information about the applicant?
Please provide name, phone or email address.
What were your age's when the relationship started? You in box 1
Office Use Only: Investigator Conducting Telephone Interview
Steven D. Ward, Director of Investigations
Kim Johnson, Operations Manager
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