City Logo
Police Logo

Applicant Drug Questionnaire

Questionnaire ID
Items marked with * are required.

In accordance with Title 74 O.S & 150.8 and the Oklahoma Drug-free Workplace Act, the Enid Police Department screens its applicants for a history of illegal drug use. The Enid Police Department is charged with enforcement of all laws of the State of Oklahoma. Therefore, illegal drug use by Enid Police Department employees would be unacceptable. To be considered for employment with the Enid Police Department, it is mandatory that applicants being considered complete this form prior to the interview. Failure to fill out this form will result in rejection of your application for employment.  
*Name * Social Security Number    
   
Please indicate whether you have used or are currently using any of the following substances. Do not include instances in which the substance was prescribed, administered, or dispensed to you by a licensed physician for treatment of a medical condition.  
Currently Using Substance?
Date Last Used
(Approx. Yr)
Total # of
Times Used
Check (x)
If NEVER Used
Marijuana Yes   No
Hashish/Hash Oil Yes   No
Cociane/Crack Yes   No
PCP Yes   No
Heroin Yes   No
Opium Yes   No
LSD Yes   No
Amphetamine/Methamphetamine
Yes   No

Derivatives:
Hydrocodone (Vicodin, Lorcet, Tussionex)
Hydromorphone (Dialudid)
Pxycodone (Perocet, Percodan)
 Yes   No

List Any Other Controlled Substance
By entering my name below, I certify that the information provided above is correct and complete. I understand any conditional offer of employment is made based upon the information provided in the Pre-Employment Application, this questionnaire, and during interviews with Enid Police Department representatives. Any misstatement of fact or omission of information may disqualify me from consideration in the hiring process or result in the withdrawal of a conditional offer if one has been made.
  *Signature * Date  
   
 
 
Top