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Confidential Questionnaire.cwk (WP)

Confidential Questionnaire.cwk (WP)

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Published by newsguy44

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Published by: newsguy44 on Jan 02, 2011
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01/02/2011

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Dear Candidate,You are being considered for appointment to asenior position of public trust by the Governor-electof the State of New Mexico that requires a reviewof your background.The Governor-elect values honesty. It’s importantto be truthful and complete when answering thesequestions. Honest answers are not necessarilydisqualifying. Failure to disclose information thatcould undermine the confidence of the people of  New Mexico in their government is disqualifyingand could be cause for termination if theinformation you provide here is later found to befalse, misleading, or incomplete.In order to properly control and protect thisconfidential information, please provide the answersto the attached questions and any additional background material related to these questions to:Office of the Governor Attn: Jessica Hernandez, GeneralCounselState Capitol Building, Suite 400
 
Santa Fe, NM 87501 This information must be provided and a reviewcompleted before you are offered a position in theGovernor-elect’s administration. 
CONFIDENTIAL CANDIDATEQUESTIONNAIRE
PERSONAL INFORMATION
1.
 
Please provide your full name, county of residence, birthplace, social security number,marital status, and list all places of residence bystreet address and community for the last ten years.If you were born outside the United States, please provide the basis for your citizenship or permanentresidency in the United States. If you are married, please list your spouse’s full name and occupation. Answer 1: 2.
 
Please list all of the schools you have attended, beginning with high school(s), and include theapproximate dates of attendance and degrees
 
earned.Answer 2:
 
3.
 
Please describe your overall health. Are youcurrently receiving medical treatment for a physicalor mental condition or illness or have you receivedany such treatment within the past two years?Answer 3:
 
4.
 
Are you now or have ever been addicted to theuse of any substance and indicate what treatment, if any,-- you have received? Answer 4: 5.
 
In the past ten years, have you used any illegaldrug? If so, please explain. Answer 5:
 
6.
 
Are you a veteran of the armed services and, if so, were you honorably discharged? If not, pleaseexplain. Were you ever subject to a court-martial?
 

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