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Human Capital Management

Supplemental Questionnaire

Last Name First Name


If you are a veteran, have you registered with the Office of Veterans Placement? If yes, make sure you upload your eligibility letter.  If no, click here to complete the registration process, and then come back to finish this application.  If you are not a veteran, please select Not Applicable and continue with this application.

Not Applicable


The Prison Rape Elimination Act (§115.17) requires that the Department of Corrections ask the following questions prior to hiring or promoting staff (please check a response to each question):


Have you ever engaged in sexual abuse in a prison, jail, lockup, community confinement facility, juvenile facility, or other institution?

Yes No

Have you ever been convicted (or civilly or administratively adjudicated) of engaging or attempting to engage in sexual activity in the community facilitated by force, overt or implied threats of force, or coercion, or if the victim did not consent or was unable to consent or refuse?

Yes No

Have you ever engaged in any incidents of sexual harassment?

Yes No

If you answered yes to questions 5, 6 , or 7, please explain:


P.R.E.A. §115.17(g):  “Material omissions regarding such misconduct, or the provision of materially false information, shall be grounds for termination.”