Preparing For Your Interview – Arizona Forensic Services, LLC

Please fill out the following information and bring the completed form to your appointment. The form takes some time to fill out, but the information you provide is essential. Please be as truthful and complete as possible.

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Your Name:

Date of Birth:

Current Age:

Today’s Date:

Height:

Weight:

Ethnic Background :

Eye Color:

Hair Color:

CHILDHOOD

Where were you born and raised:

Who helped raise you:

If your parents ever divorced, how old were you when this happened?

Briefly describe your father (his personality , work, did he have problems with alcohol, drugs or mental health?

Briefly describe your mother: (her personality, work, did she have problems with alcohol, drugs or mental health?)

If you were raised by a stepparent, grandparent, a parent’s boyfriend/girlfriend, foster parent or other, please describe them:

Please give the ages and brief description of your siblings, step – siblings or half – siblings. Do they have any problems with alcohol, drugs, or mental health?

In general, how would you describe your childhood growing up:

Have you ever been a member of a gang or hung out with gang members?

YOUR EDUCATION

In general, how was grade school? What were your grades like?

In general, how was middle school? What were your grades like?

In general, how was high school? What were your gr ades like?

Did you repeat any grades ?

Were you diagnosed ADD or ADHD?

Did you have Special Ed classes? If “ yes ”, what academic problems did you have?

Were you ever suspended or expelled? If “ yes ” – describe what happened:

High School Diploma:

Yes

High School G.E.D.:

Yes

College classes?

College Degree ?

YOUR MOST RECENT EMPLOYMENT

Employed by:

Job description :

How long?

PAST EMPLOYMENT:

Beginning with your first job, list . . .

Job title:

Reason this job ended:

How long employed:

Job title:

Reason this job ended:

How long employed:

Job title:

Reason this job ended:

How long employed:

Job title:

Reason this job ended:

How long employed:

Job title:

Reason this job ended:

How long employed:

Did you ever serve in the military?

Are you on Social Security Disability?