Were you ever fired, terminated, discharged, or asked to resign from any of the aforementioned positions? NO YES If yes, give details:

Has any disciplinary action (i.e., memorandum, suspension) other than referred to above been taken against you in connection with employment or any position that you have held? NO YES If yes, give details:

Have you ever as a condition of appointment to or retention of a position been required to submit to a lie detector test or any other mechanical or electronic test designed to test your truthfulness? NO YES If yes, give details:

Has any employer or agency ever conducted a background or character investigation concerning your fitness for a position? NO YES If yes, give details: