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- Form RC-5 "Self Evaluation Questionnaire" - Texas
Form RC-5 "Self Evaluation Questionnaire" - Texas
What Is Form RC-5?
This is a legal form that was released by the Texas Department of Public Safety - a government authority operating within Texas. As of today, no separate filing guidelines for the form are provided by the issuing department.
Form Details:
- Released on March 1, 2020;
- The latest edition provided by the Texas Department of Public Safety;
- Easy to use and ready to print;
- Quick to customize;
- Compatible with most PDF-viewing applications;
- Fill out the form in our online filing application.
Download a fillable version of Form RC-5 by clicking the link below or browse more documents and templates provided by the Texas Department of Public Safety.
![Form RC-5 "Self Evaluation Questionnaire" - Texas](https://data.templateroller.com/pdf_docs_html/2069/20697/2069726/page_1_thumb.png "Form RC-5 "Self Evaluation Questionnaire" - Texas")
1![Form RC-5 "Self Evaluation Questionnaire" - Texas, Page 2](https://data.templateroller.com/pdf_docs_html/2069/20697/2069726/page_2_thumb.png "Form RC-5 "Self Evaluation Questionnaire" - Texas, Page 2")
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14TEXAS DEPARTMENT OF PUBLIC SAFETY
APPLICANT
SELF EVALUATION QUESTIONNAIRE
NAME
DATE
LOCATION (City and State):
I CERTIFY THAT THE ANSWERS I WILL GIVE ARE TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE AND
BELIEF, AND I AGREE THAT ANY MISSTATEMENT OR OMISSION AS TO A MATERIAL FACT WILL CONSTITUTE
GROUNDS FOR IMMEDIATE DISMISSAL OR REJECTION OF MY APPLICATION. I HEREBY GRANT AUTHORIZATION
TO THE TEXAS DEPARTMENT OF PUBLIC SAFETY TO CONTACT ANY PERSON OR ORGANIZATION FOR
INFORMATION AND/OR DOCUMENTS TO VERIFY THE VALIDITY OF ANY PREVIOUS STATEMENT REGARDING MY
PREVIOUS EMPLOYMENT, CHARACTER, AND CONDUCT.
With few exceptions, you have the right to request and be informed about information that the State of Texas
collects about you. You are entitled to receive and review the information upon request. You also have the right
to ask the state agency to correct any information that is determined to be incorrect. (Reference: Government
Code, Sections 522.021, 522.023 and 559.004.)
(Signature of Applicant)
(Witness)
RC-5 Revised March 2020
Page 1
TEXAS DEPARTMENT OF PUBLIC SAFETY
APPLICANT
SELF EVALUATION QUESTIONNAIRE
NAME
DATE
LOCATION (City and State):
I CERTIFY THAT THE ANSWERS I WILL GIVE ARE TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE AND
BELIEF, AND I AGREE THAT ANY MISSTATEMENT OR OMISSION AS TO A MATERIAL FACT WILL CONSTITUTE
GROUNDS FOR IMMEDIATE DISMISSAL OR REJECTION OF MY APPLICATION. I HEREBY GRANT AUTHORIZATION
TO THE TEXAS DEPARTMENT OF PUBLIC SAFETY TO CONTACT ANY PERSON OR ORGANIZATION FOR
INFORMATION AND/OR DOCUMENTS TO VERIFY THE VALIDITY OF ANY PREVIOUS STATEMENT REGARDING MY
PREVIOUS EMPLOYMENT, CHARACTER, AND CONDUCT.
With few exceptions, you have the right to request and be informed about information that the State of Texas
collects about you. You are entitled to receive and review the information upon request. You also have the right
to ask the state agency to correct any information that is determined to be incorrect. (Reference: Government
Code, Sections 522.021, 522.023 and 559.004.)
(Signature of Applicant)
(Witness)
RC-5 Revised March 2020
Page 1
INSTRUCTIONS TO APPICANT:
Make sure all questions are answered completely. If a question is not applicable, write “NA”. Write “Unknown”
only if the answer is not known. If an exact answer to a question that asks for a numerical response is not
known, give a best estimate. If the answer to a question is zero, write a “0”on the blank.
Please print or write clearly.
I.
BACKGROUND DATA
A. Why do you want to be a Trooper? (Give a brief summary of the reasons.)
II.
DRIVING HABITS
A. Explain how you think others would evaluate your driving habits?
B. How would you describe your driving habits? (Please explain)
III.
ATTITUDE TOWARD MILITARY
A. If you have not served in the military, answer the following question, then skip to section IV Education.
If you have served, skip to section B and continue.
1. How would you feel about serving in the military? (Explain why you decided not to serve)
RC-5 Revised March 2020
Page 2
B. If you have served in the military including reserves, answer the following questions:
1. How would you describe your ability to adapt to military service?
2. How would you describe the problems (if any) you had during your military service?
3. What kind of adjustment problems (if any) did you experience?
4. What did you like and dislike about your military service?
Likes:
Dislikes:
5. What did you think of your supervisors?
6. Explain the ways in which you believe your military experience will benefit you as a Trooper?
RC-5 Revised March 2020
Page 3
7. In the space below explain any unusual situations which occurred during your military experience.
IV.
EDUCATION
A. Describe your attitude toward high school.
B. Describe your attitude toward college.
C. Describe the ways in which you believe your education has/will benefit you.
D. In the space below explain any unusual situations which occurred during your educational years.
V.
WORK HISTORY
A. Answer the following questions regarding your CURRENT or LAST job:
1. What kinds of problems, if any, do (or did) you have with your co-workers?
RC-5 Revised March 2020
Page 4
2. How would your present (or past) supervisor evaluate you on your work?
3. What would he or she say are your strong points and weak points?
4. On a four-point scale, with 1 = very favorably, 2 = favorably, 3 = unfavorably, and 4 = very
unfavorably, how would your supervisor evaluate you on: (Put a number on each blank.)
______ Initiative and resourcefulness
______ Willingness to follow orders
______ Ability to make decisions
______ Perseverance or the ability to stick with something
______ Sense of responsibility
______ Honesty
______ Ability to plan and organize
______ Leadership ability
______ Ability to get along with co-workers
______ Absenteeism record
5. If you were ever fired, laid off, or asked to resign, explain why.
RC-5 Revised March 2020
Page 5
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