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Except for minor office supplies, what is the total value of goods and merchandise not belonging to you that you have taken from all of your employers in the last 5 years?
$0
up to $5
up to $10
$11 or more
I don’t remember

The total amount of cash not belonging to you that you have taken from all of your employers in the past 5 years is?
$0
up to $5
up to $10
$11 or more
I don’t remember

How often do you currently use cocaine, crack or other illegal drugs (LSD, speed, amphetamines, ice, etc.) while at work or just before?
Daily
One to four times per week
One to four times per month
Tried once or twice
Never

The total value of items you have taken from a store without paying for it, in the last five years?
$0
Up to $5
$5 to $10
More than $11
I don’t remember

Have you ever committed a theft, shoplifting or other crime where you took something that didn’t belong to you?
Yes
No

How often have you ignored safety rules in order to get the job done in the past three years?
Never
1 or 2 times
3 or 4 times
5 or more times