Laserfiche WebLink
M11. Have you ever seriously considered committing suicide? <br /> a. No <br /> b. Yes <br /> IF YOU ANSWERED"NO",SKIP TO QUESTION M13. <br /> IF YOU ANSWERED"YES",CONTINUE WITH QUESTION M12. <br /> M12. When was the last time you seriously considered committing suicide?(MARK ONE <br /> ANSWER ONLY.) <br /> a. Within the last 12 months <br /> b. Between one and two years ago <br /> c. Between three and five years ago <br /> d. More than five years ago <br /> M13. Have you ever attempted suicide? <br /> a. No <br /> b. Yes <br /> IF YOU ANSWERED"NO",SKIP TO QUESTION N1. <br /> IF YOU ANSWERED''YES",CONTINUE WITH QUESTION M14. <br /> M14. When was the last time you attempted suicide?(MARK ONE ANSWER ONLY.) <br /> a. Within the last 12 months <br /> b. Between one and two years ago <br /> c. Between three and five years ago <br /> d. More than five years ago <br /> JOB RELEVANT SEXUAL HISTORY <br /> Note: Your answers to the following questions may be verified by checks of records kept by police <br /> agencies, courts, and social service agencies, and by interviews with persons acquainted with <br /> you. If you deliberately give false or misleading answers, you may be disqualified. <br /> N1. Have you ever used the services of a prostitute? <br /> a. No <br /> b. Yes, 1 time <br /> c. Yes, 2 times <br /> d. Yes, 3 or more times <br /> N2. Have you ever provided sexual services for money or goods? <br /> a. No <br /> b. Yes <br /> N3. Have you ever had sexual contact with someone 14 years old or younger? <br /> a. No <br /> b. Yes,when I was 16 years old or younger <br /> c. Yes, when I was 17-18 years old <br /> d. Yes,when I was more than 18 years old <br /> PSS/LEPS PLLC 98 <br />