Can
You Pass Obama's Job Questionnaire? If you have the time and patience required,
answer Obama's seven section, 63 question job application pre-screen questionnaire.
All those applying must do so, before they will be considered for employment by
the Barack Hussein Obama. If you can't pass it, don't feel bad. Obama and most
of his current staff wouldn't get hired using his own standards. The hypocrisy
of the liberals is endless.
I. Professional Employment
(1) Please furnish
copies of all resumes and biographical statements issued by you or any other entity
at your discretion or with your consent within the past ten years.
(2) If you
are a member of any licensed profession or occupation, please specify the following:
the present status of each license; whether any such license has ever been withdrawn,
suspended, or revoked; whether any disciplinary action of any kind has ever been
taken in connection with your license. Please also list any applications for professional
licenses or certifications that my have been denied, and the reasons for denial.
(3)
Please provide the names of all corporations, firms, partnerships, trusts, or
other business enterprises, and all non-profit organizations and other such institutions
with which you are now, or during the past ten years have been, affiliated with
as an advisor, attorney or consultant.
(4) Please chronologically list activities,
other than those listed on your resume or biography, from which you have derived
earned income (e.g., self-employment, consulting activities, writing, speaking,
royalties and honoraria) for the past ten years.
(5) Have you or your spouse
ever registered as a lobbyist or other legislative agent to influence federal
or state legislation or administrative acts? Have you or your spouse ever received
payment for acting as a lobbyist or legislative agent? If so, please supply details.
(6)
If you or your spouse have performed any work for, received any payments from
and/or made any payments to any foreign government, business, non-profit organization
or individual, please describe the circumstances, and identify the source and
amount. Also please specify if you or your spouse have ever been registered as
an agent for a foreign principal.
(7) If you or your spouse have ever lived
or worked abroad, please describe the circumstances.
(8) Briefly describe the
most controversial matters you have been involved with during the course of your
career.
(9) Please provide the names, addresses and telephone numbers of three
professional references. If possible, please furnish names of individuals with
whom you have worked as a peer, a subordinate and as a supervisor.
II. Publications,
Writings & Speeches
(10) Writings: Please list and, if readily available,
provide a copy of each book, article, column or publication (including but not
limited to any posts or comments on blogs or other websites) you have authored,
individually or with others. Please list all aliases or "handles" you
have used to communicate on the Internet.
(11) Testimony: Please identify each
instance in which you have testified before Congress or other legislative, administrative,
investigative or regulatory body and specify the subject matter of the testimony.
If available, please provide summaries or transcripts of your testimony.
(12)
Speeches: Please identify all speeches you have given. If available please provide
the test or recordings of each such speech or identify any recordings of speeches
of which you are aware.
(13) Electronic communications: If you have ever sent
an electronic communication, including but not limited to an email, text message
or instant message, that could suggest a conflict or interest or be a possible
source of embarrassment to you, your family, or the President-Elect if it were
made public, please describe.
(14) Diaries: If you keep or have ever kept a
diary that contains anything that could suggest a conflict of interest or be a
possible source of embarrassment to you, your family, or the President-Elect if
it were made public, please describe.
III Relationships & Affiliations
(15)
Please list all corporations, partnerships, trusts, or other business entities
with which you or your spouse have ever been affiliated as an officer, director,
trustee, partner, or holder of a significant equity or financial interest ( i.e.
any ownership interest of more than 5%), or whose decisions you or your spouse
had the ability to influence. Please identify the entity, your relationship to
the entity, and dates of service and/or affiliation.
(16) Please list each membership,
including any board memberships, you or your spouse have or have had with any
political, civic, social, charitable, educational, professional, fraternal, benevolent
or religious organization, private club or other membership organization (including
any type of tax-exempt organization) during the past ten years. Please include
dates of membership and any positions you may have had with the organization.
(17)
Have you or your spouse at any time belonged to any membership organization, including
but not limited to those described in the preceding paragraph, that as a matter
of policy or practice, denied or restricted membership or affiliation based on
race, sex, disability, ethnic background, religion or sexual orientation or has
been subject to a claim that it has done so? If so, please provide details.
(18)
Please specifically describe any affiliation you, or your spouse or any member
of your immediate family have, or have had, with any financial, banking, mortgage
or insurance institution that is currently the subject of federal government intervention
as part of the ongoing economic crisis. This question includes, but is not limited
to, the following: Fannie Mac, Freddie Mac, AIG, and Washington Mutual.
(19)
If you currently serve or in the last ten years have served as an administrator,
executor, trustee, receiver, or in any other similar fiduciary capacity, please
describe for each: your exact position; the nature of your duties; the persons
or entities for whom you act(ed) as a fiduciary; the dates during which you served
in such a fiduciary capacity; and any supervising courts.
(20) Other than the
entities identified in questions 15-19 above, please provide the names and details
of any individuals and organizations with which you or your spouse have been associated
with which might present a conflict of interest with your proposed federal office,
or have the potential for embarrassment.
IV. Financial Information
(21)
Please provide copies of all financial disclosure forms you or your spouse have
been required to file within the past ten years, if applicable.
(22) Please
furnish a copy of each net worth statement that you have prepared and submitted
for any purpose (e.g., bank loans) during the past ten years.
(23) Please furnish
a copy of all brokerage statements for investment accounts for the past year.
(24)
Please list all loans in excess of $10,000 made to you or your spouse, or by you
or your spouse, which existed at anytime during the past ten years. Please specify
the creditor or debtor, interest rate, due date and any other key terms, and identify
the purpose for which the liability was incurred. Please also specify the extent
to which any such loans contained terms not generally available to the public,
such as below-market rates.
(25) Please furnish a copy of each trust of which
you, your spouse or any child under 21 is a grantor or beneficiary. Also please
furnish a copy of any amendment, and any document indicating a change in trustee
of any such trust.
(26) Please describe all real estate held in your name or
in your spouse's name during the last ten years. Please include real estate held
in combination with others, held in trust, held by a nominee, or held by or through
any other third person or titleholding entity, and identify such other person
or entity.
(27) Please describe the mortgage terms for any properties listed
under question 21, including the rate, date, holder, service entity, and any special
circumstances surrounding the acquisition of the mortgage(s).
(28) Have you
or your spouse at any time held property (as a named owner of record individually
or in combination with others) the title to which contained any restrictive covenant
based on race, sex, ethnic background, religion or sexual orientation? If so,
please provide all relevant information and records.
(29) Please describe any
contractual or informal arrangement you may have made with any person or business
enterprise in regard to future employment or termination payments or financial
benefits that will be provided to you if you enter federal government employment
or you leave your current employment.
(30) Do you, your spouse, or any member
of your immediate family, or business in which you , your spouse, or immediate
family member have a substantial interest, have any relationship with any government,
whether federal, state, local, Indian or foreign, through contracts, consulting
services, grants, loans or guarantees? If yes, please provide details.
(31)
Are there any categories of personal financial records (e.g., individual, partnership
or sole proprietorship tax returns, mortgage documents, loan agreements) that
you(or your spouse) will not release publicly if necessary? If so, please identify
these records and state the reasons for withholding them.
(32) Other than from
relatives, or from close and longstanding personal friends on occasions such as
birthdays or seasonal holidays, have you or your spouse ever received a gift exceeding
$50.00 in value? Please identify the donor, the value of the gift, the date received
and the circumstances in which the gift was made.
V. Tax Information
(33)
Please furnish a copy of each federal and state (and, if applicable, municipal
or foreign) tax return, including any amended return, for 2005 and all subsequent
years. If filed separately, furnish the same documents for your spouse.
(34)
Have you and your spouse filed all required federal, state, local and foreign
income tax returns?
(35) Have you or your spouse ever filed a late tax return
without a valid extension? If
so describe the circumstances and resolution
of the matter.
(36) Have you ever paid any tax penalties? If so, describe the
circumstances and the resolution of the matter.
(37) Has a tax lien or other
collection procedure ever been instituted against you or your spouse by federal,
state or local authorities? If so, describe the circumstances and the resolution
of the matter.
(38) Have you ever not paid U.S. and/or state income taxes because
you were not resident in the United States, or for any other reason?
(39) Have
you been or do you have any expectation that you will be the subject of any tax,
financial, or other audit or inquiry? If so, please describe.
(40) Have you
ever participated in an investment program or partnership which has been audited
or investigated by federal, state or local authorities? If so, describe the circumstances
and the resolution of the matter.
(41) Please answer each of the questions in
this section for your spouse (for the past ten years) and for any business with
which you have been affiliated as an officer, director, partner, trustee or significant
owner (i.e., any ownership interest of more than 5%).
VI. Legal and Administrative
Proceedings
(42) Please list any lawsuits you or your spouse have brought
as a plaintiff or which were brought against you or your spouse as a defendant
or third party, or in which you or your spouse have testified at trial or deposition.
Include in this response any arbitrations, mediations, and contested divorce proceedings
or other domestic relations matters.
(43) Please list and describe any administrative
agency proceedings in which you or your spouse have been involved as a party or
material witness, and describe the details of your involvement.
(44) Please
list any insolvency or bankruptcy proceedings in which you or your spouse have
been involved as a debtor, creditor, claimant, or defendant, and describe details
of that involvement.
(45) If you have ever been investigated by any law enforcement
agency (whether federal, state, military, local, Indian or foreign), arrested
for, charged with, or convicted of violating any law, regulation or ordinance
(whether federal, state, military, local, Indian or foreign), please identify
each such instance and supply details, including: date, place; law enforcement
agency; and court. Provide the same information for your spouse and for each child
over 21, and for any business with which you have been affiliated (e.g., as a
director, officer, partner, trustee, or holder of any significant ownership interest),
and furnish all pertinent records. You may exclude traffic offenses for which
the fine was less than $50.
(46) Have any members of your family or close social
or business associates been arrested for, charged with and/or convicted of a crime,
other than a minor traffic violation? If so, please identify and describe each
such arrest, charge or conviction. Please provide the same information for anyone
under your professional supervision, or anyone of your superiors.
(47) Have
you or your spouse ever been accused, formally or informally, of any violation
of government or agency procedure (specifically including security violations)?
(48)
Please list any complaint ever made against you or your spouse by any administrative
agency, regulatory body, professional association or organization, or federal,
state, local, Indian or foreign ethics agency, committee, or official.
(49)
Please list any malpractice claim made against you, formally or informally, and
describe the resolution of the matter.
(50) Please list any claims of sexual
harassment of other workplace misconduct, made against you or any employee directly
supervised by you, including the resolution of the matter.
(51) Have any civil
judgments or liens been rendered against you or your spouse? If so, please provide
details.
(52) With regard to each obligation of child support and/or alimony
owed by you or your spouse, please state the following: Have any payments been
made late or have there been any lapses in payment? Have any motions or court
actions for modification of child support or alimony been filed or instituted?
Have any actions or motions to compel payment or initiate collection of late payments
and/or past due amounts been filed or threatened? Have any writs of garnishment
been issued? If yes, please provide details.
VII. Domestic Help
(53)
Do you presently have or have you in the past had occasional (to be sure, a monthly
housekeeper is covered) or regular domestic help? (e.g., a housekeeper, babysitter,
nanny or gardener) If yes, please indicate the name and years of service for each
individual and also provide a brief description of the services rendered.
(54)
Were all individuals listed in Question 49 legally eligible to work in the U.S.
at the time that you employed them?
(55) Have you paid all taxes and social
security obligations applicable to the employment of the individuals listed in
Question 49? Do you use an outside service to pay such individuals? Have all payments
related to the employment of these individuals been made in a timely fashion?
If not, please identify the length and reason for the delay(s).
(56) Have you
complied with all federal, state and local laws and regulations related to the
employment of individuals listed in Question 49?
VIII. Miscellaneous
(57)
If applicable, please list the names, addresses and phone number of cohabitants
within the last ten years. A cohabitant is a person with whom you share bonds
of affection, obligation, or other commitment, as opposed to a person with whom
you live for reasons of convenience (roommate).
(58) Please provide the URL
address of any websites that feature you in either a personal or professional
capacity (e.g., Facebook, My Space, etc.)
(59) Do you or any members of your
immediate family own a gun? If so, provide complete ownership and registration
information. Has the registration ever lapsed? Please also describe how and by
whom it is used and whether it has been the cause of any personal injuries or
property damage.
(60) Have you had a complete physical within the past year?
Please describe your overall health and any medical treatment you are currently
receiving.
(61) Have you had any association with any person, group or business
venture that
could be used - even unfairly - to impugn or attack your character
and qualifications for government service?
(62) Do you know anyone or any organization,
either in the private sector or government service, that might take steps, overtly
or covertly, fairly or unfairly, to criticize your nomination, including any news
organization? If so, please identify and explain the potential basis for criticism.
(63)
Please provide any other information, including information about other members
of your family, that could suggest a conflict of interest or be a possible source
of embarrassment to you, your family, or the President-Elect.
Release
Authorization Pursuant to the FCRA (15 U.S.C. sec. 1681)
This
is a release for the Obama Transition Foundation to obtain one or more consumer
and/or credit reports about you in connection with your consideration for employment
in the Federal Government. Please read the following carefully and indicate your
assent.
DISCLOSURE
As part of the employment process,
the Obama Transition Foundation will obtain a consumer report (known as an investigative
consumer report in California), which I understand may include information regarding
my credit worthiness, credit standing, credit capacity, character, general reputation,
personal characteristics, or mode of living.
AUTHORIZATION
During
the application process, I hereby authorize ChoicePoint WorkPlace Solutions Inc.,
on behalf of the Obama Transition Foundation, to procure a consumer report (known
as an investigative consumer report in California), which I understand may include
information regarding my credit worthiness, credit standing, credit capacity,
character, general reputation, personal characteristics, or mode of living. This
report may be compiled with information from credit bureaus, courts record repositories,
departments of motor vehicles, past or present employers and educational institutions,
governmental occupational licensing or registration entities, business or personal
references, and any other source required to verify information that I have voluntarily
supplied. I understand that I may request a complete and accurate disclosure of
the nature and scope of the background verification, to the extent such investigation
includes information bearing on my character, general reputation, personal characteristics
or mode of living.
_________________________________ ________________
Applicant
Name and Signature Date
________-____-________ ___________________
Social
Security Number* Date of Birth*
*For Identification Purposes Only
CA,
MN & Oklahoma Residents please note: In connection with your application
for employment, your consumer report may be obtained and reviewed. Under California,
Minnesota and Oklahoma law, you have a right to receive a free copy of your consumer
report by checking the appropriate box below.
___ YES, I am a California
resident and would like a free copy of my investigative consumer report.
___
YES, I am a Minnesota resident and would like a free copy of my consumer report.
___
YES, I am an Oklahoma resident and would like a free copy of my consumer report.
CA
Residents please note: In connection with your application for employment,
your credit report will be obtained and reviewed. Under CA law, you have a right
to receive a free copy of your credit report by checking the appropriate box below.
Your credit report will be mailed to you by the credit bureau. Please note, if
you elected to receive the entire investigative consumer report, this will include
your credit report.
___ YES, I am a California resident and would
like a free copy of my credit report.
Printed Name ___________________________________
Street
Address __________________________________
City, State, Zip __________________________________
CALIFORNIA
DISCLOSURE
As part of the employment process, the Obama Transition
Foundation will obtain an investigative consumer report. The investigative consumer
report may include information regarding your credit worthiness, credit standing
credit capacity, character, general reputation, personal characteristics or mode
of living. The following Consumer Reporting Agency will prepare the report:
ChoicePoint
WorkPlace Solutions Inc.
Consumer Disclosure Center
PO Box 105292
Atlanta,
GA 30348
1-800-845-6004
California Notice:
You have
the right under Section 1786.22 of the California Civil Code to contact ChoicePoint
during normal business hours to obtain your file for your review. You may obtain
such information as follows:
1. In person at ChoicePoint's office
at the address listed above. You will need to furnish
proper identification
prior to receiving your file. You may have someone accompany you and should inform
such person that they will also have to present reasonable identification. If
you want ChoicePoint to disclose to or discuss your information with this third
party, you may be required to provide a written statement granting ChoicePoint
permission to do so.
2. By certified mail, if you make a written request
(and provide proper identification) to have your file sent to a specified addressee.
3.
By telephone, if you have previously made a written request and provided proper
identification.
ChoicePoint has trained personnel to explain any information that is furnished
to you and to explain any information that is coded.
