Employee Possessor Questionnaire

An employee possessor questionnaire is a form that needs to be filled up by every employee possessor of a Federal explosives licensee, a permittee or an applicant. Employee possessor means someone who controls and possesses explosive materials during the course of his employment, for eg, a blaster, miner or someone like a construction worker who is in charge of the keys for magazines where explosives are kept.

Sample Employee Possessor Questionnaire:

Name: _______________________

Address: ___________

Date of birth: _________

Social security number: _________

Phone Number: ________________

1)   Please give the name and the address of the explosives business where you are an employee possessor. ___________

2)   What is your designation and role at the explosives business or operations? _________

3)   Please mention your Federal explosives license/permit number for explosives business or operations. _________

4)   Mention all countries of citizenship held by you. ____________

5)   If you are not a US citizen, specify your US-issued alien number or admission number. __________

6)   Are you a fugitive from justice?

a)   Yes

b)   No

7)   Do you use, or are addicted to, marijuana, stimulant or any depressant, narcotic drugs, or controlled substances?

a)   Yes

b)   No

8)   Have you ever been convicted of a felony, or any other crime, for which you could have been imprisoned for more than one year?

a)   Yes

b)   No

9)   Have you ever been admitted to a mental institution or diagnosed as mentally defective or incapable of managing your own affairs?

a)   Yes

b)   No

10)               Have you ever been discharged from the US Armed Forces under dishonourable conditions?

a)   Yes

b)   No

Category: Employment Questionnaire