HR CTPAT Questionnaire

HR CTPAT QUESTIONNAIRE

Purpose: This questionnaire collects personnel, employment and security-related information for assessment under the Customs-Trade Partnership Against Terrorism (CTPAT) security program. Complete all sections fully and truthfully. False statements or omissions may result in disciplinary action, denial of access privileges, or termination.

Personal Information

Date of Birth:   Last four digits of SSN:

Position Information

Proposed/Actual Start Date:   Facility/Location:

Physical access to cargo handling areas    Access to shipping/manifest systems    Authorization to sign or approve shipping documents

CTPAT / Security-Specific Questions

Have you received formal CTPAT or equivalent supply-chain security training?    Yes    No

Will the position require unsupervised access to sealed cargo or containers?    Yes    No

Does the role include authority to approve shipments, manifests, bills of lading, or release of goods?    Yes    No

Foreign Travel / Dual Nationality

Have you traveled internationally for business or personal reasons in the last five years?    Yes    No

Do you hold dual citizenship or residency in another country?    Yes    No

Criminal / Security History

Have you ever been convicted of, pled guilty to, or received deferred adjudication for a felony or misdemeanor involving dishonesty, fraud, theft, or a security-related offense?    Yes    No

Employment History (Most Recent First)

Education

Graduation/Completion Date:

References (Professional)

Legal Disclosures & Authorizations

At-Will Employment: Nothing in this questionnaire or in any communication or policy shall be construed to create a contract for employment. Employment is at-will and may be terminated by either the employee or the employer at any time, with or without cause or notice, unless an express written agreement states otherwise.

Equal Opportunity: The company is an equal opportunity employer. Decisions will be made in accordance with applicable laws prohibiting discrimination.

Authorization to Verify and Release Information: By signing below, I authorize the company and its agents to verify the information provided, to contact current and former employers, educational institutions, references, governmental entities and law enforcement authorities, and to obtain consumer and/or investigative background reports where permitted by law. I authorize these entities to release any information concerning my employment, character, education, criminal record, and other matters related to my suitability for employment or access privileges.

Security Clearance and Access Conditions: I understand that assignment to positions that grant access to cargo, manifests, export/import records, or controlled facilities may be conditioned on successful background checks and continued compliance with security protocols. I agree to comply with site security procedures, badge and container-seal policies, and to report security concerns or suspicious activity immediately to my supervisor.

Certification of Truthfulness: I certify that the information provided in this questionnaire is true, correct, and complete to the best of my knowledge. I understand that omissions or false statements may disqualify me from employment or lead to disciplinary action, up to and including termination.

Consent to Investigation Acknowledgement: I understand that the employer may retain this questionnaire and may use it to evaluate security risk and eligibility for access. I release from liability all persons and entities providing information to the employer in good faith, and I waive any claim against them for providing such information.

Applicant Certification and Signature

I certify under penalty of perjury that the foregoing information is true and complete. I have read and understand the authorizations, disclosures, and security obligations set forth above. I agree to notify the employer promptly of any change in the information provided that affects my suitability for access to cargo, shipping documentation, secure areas, or participation in CTPAT-related activities.

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