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BEHAVIORAL AND ETHICAL DISCLOSURES
Please state/answer YES OR NO. Where YES please provide FULL explanation to help us assess the circumstances and secure comfort that you are fully rehabilitated and have/will take every step to ensure this never again occurs. I have a history of/ current problem of:
Misuse/misplacement of your school fees
*
No
Yes, provide full details:
Signing a library book and failing to return it in time
*
No
Yes, provide full details:
Written warning at school or workplace
*
No
Yes, provide full details:
Dismissal from school or workplace
*
No
Yes, provide full details:
Vandalism
*
No
Yes, provide full details:
Assault
*
No
Yes, provide full details:
Alchoholism
*
No
Yes, provide full details:
Smoking
*
No
Yes, provide full details:
Crime/criminal record
*
No
Yes, provide full details:
Any misdemeanor
*
No
Yes, provide full details:
Other Pertinent Matters
Please state any other matters you consider pertinent in relation to your health, and/or moral character etc worthy of our attention. (500 words maximum)
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