APPLICANT QUESTIONNAIRE

In order for the University to fully and completely evaluate how each of the finalists meets the qualifications for this extremely sensitive, high-level position, we are requesting that you complete this questionnaire. This position would require the incumbent to exercise sound judgement, and completion of the questionnaire will help avoid any misunderstandings or adverse publicity for the University in the future. The information that you provide will be treated as confidential to the extent permitted by law.

YES     NO
            1. Have you ever had any criminal charges brought against you, as an adult, by any military or civilian law enforcement agencies that resulted in a conviction; or, do you have pending criminal charges?

YES     NO
            2. Have you ever been involved in any activity or engaged in any conduct of such a serious nature that, if it were disclosed to the public, might lessen your effectiveness in this position or cause adverse publicity to the University? (If you are uncertain about the significance to the University of conduct in your past or if you are uncertain about how the activity or conduct in question might affect your suitability for this position, please discuss the matter with the hiring official in charge of this search prior to completing this questionnaire.)

I hearby certify that all statements I have provided in response to this questionnaire are accurate and true to the best of my knowledge and belief. In addition, I hearby grant permission to the University to obtain further background information about me from any pertinent source, including references listed in my application.

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revised 01/05/99