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Placer County Human Resources Department
#2018-16330-01


Supplemental Questionnaire

Last Name First Name
 

 

Conviction History


 

Have you been convicted of a crime?

Yes No

 

Please note conviction of a crime is not necessarily a bar to employment.  Each case is considered separately based upon specific job requirements. 

You must disclose all convictions, including reckless and drunk driving convictions even if:

  • It happened a long time ago
  • It was only a misdemeanor;
  • You didn’t have to go to court (your attorney went for you);
  • You had no jail time or the sentence was only a fine or probation;
  • You received a certificate of rehabilitation;
  • The conviction was later dismissed, set aside or the sentence was suspended.

You may OMIT:   

  • Minor traffic violations;
  • Any offense committed prior to your 18th birthday which was formally adjudicated in a Juvenile Court or under a youth offender law;
  • Any incident sealed under Welfare & Institutions Code 781 or Penal Code 1203.45;
  • Any offenses committed under Health & Safety Codes 11357(b) or (c); 11360(c); 11364; 11365 or 11550 as related to marijuana prior to 1/1/1976 or any other conviction mentioned in Labor Code 432.8.

 

If YES, please state:  1) date, 2) charge, 3) place, 4) court, and 5) action taken in the space below.

If NO, please enter N/A.


 

Thank you for completing the supplemental portion of the application process. We encourage applicants to review their responses for accuracy prior to submitting.

Please "Save & Continue" to move forward to the next tab in the application process.

Be sure to click the "Submit" button once the application and supplemental questionnaire have been completed.