Application

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Refer to the list below of substances as the reference for all questions regarding unauthorized or illegal use of drugs.

For the purpose of responding to the following questions, "Illegal drugs" include the unauthorized use of prescription medications or over-the-counter drugs; it also includes the illegal use of any other substances for the purpose of getting "high."

Your responses should include - but not be limited to - your use of any of the following:

• Amphetamines / Methamphetamines (Uppers, Speed, Crank, etc)
• Barbiturates (Downers)
• Cocaine / Crack Cocaine
• Designer Drugs (Ecstasy, Synthetic Heroin, etc.)
• GHB (Date Rape Drug)
• Hallucinogens (Peyote, LSD, Mushrooms)
• Hashish / Hashish Oil
• Heroin / Opium
• Marijuana (with or without a prescription)
• Synthetic Marijuana known as K2
• Mescaline
• Morphine
• PCP / Angel Dust
• Quaaludes
• Steroids
• Tetrahydrocannabinal (THC)
• Glue, paint, or any substance containing toluene



Have you ever used any of the above substances?

Yes:
No:
If yes, list all substances taken along with details including the last time you used it.



Have you EVER engaged in selling, manufacturing, purchasing, furnishing, cultivating, carrying or holding for another ANY illegal substances, including marijuana, or any other drugs you were not professionally prescribed?

Yes:
No:
If yes, list all details including the date of the last occurrence.



Are you now, or have you ever been in ANY branch of the military?

Yes:
No:
If yes, please Branch of Service and Years Served.



Have you EVER been detained by law enforcement for investigation, arrested, indicted, charged, or convicted of any misdemeanor or felony offense in this state or any other legal jurisdiction (including offenses in the Uniform Code of Military Justice)?

Yes:
No:
If yes, provide the felony or misdemeanor, the circumstances and dates the incident occurred.

I agree to the conditions and certify that all statements made by me on this application are true, correct and complete, to the best of my knowledge.