Personal Reference Questionnaire

NORTH CAROLINA
ALARM SYSTEMS LICENSING BOARD
3101 Industrial Drive • Suite 104
Raleigh, North Carolina 27609
Phone: (919) 788-5320
E-Mail: [email protected]
Web Page : www.ncdps.gov/ASL.aspx

PERSONAL REFERENCE QUESTIONNAIRE

TO APPLICANT: Print your name, the date and phone number below and have each of your character references complete the personal reference questionnaire. This form will be uploaded during your application process. Keep the original with your application confirmation page as it may be requested for review by your assigned investigator.

Name: __________________________________________________ Date: ________________ License Type: _________________________________ Ph: ________________

***YOUR APPLICATION WILL NOT BE PRESENTED TO THE BOARD UNTIL ALL REFERENCES HAVE BEEN RECEIVED***

REFERENCE: This questionnaire is to be completed by the reference only, signature notarized and returned to Applicant.

How long have you known the applicant? __________________________________________________________________________________________________

Do you know him/her personally or professionally? _________________________________________________________________________________________

Have you ever known the applicant to have alcohol or drug problems? _________________________________________________________________________

What kind of person do you think he/she is and how would you summarize his/her moral character? __________________________________________________
_______________________________________________________________________________________________________________________________________
_______________________________________________________________________________________________________________________________________

Have you ever observed or had knowledge of the applicant doing anything you felt was illegal or questionable? ________________________________________
_______________________________________________________________________________________________________________________________________

Is there anything else about the applicant that has not been asked that you feel we need to know about him/her before we grant the applicant a license? ________
_______________________________________________________________________________________________________________________________________

Would you recommend the applicant for the license that he/she has requested? ____________________________________________________________________

Reference Name: _________________________________________________________ Date: _________________________________

Signature: ____________________________________________________________________

Address: City/State/Zip _____________________________________________________________________________________________________

Telephone: _________________________________________________________

THE ABOVE WAS SWORN AND SUBSCRIBED BEFORE ME THIS

The ________________ Day of _________________________________, 20________

___________________________________________________
Notary Public
My Commission Expires: _________________________________

(SEAL)