Good Cause Statement Questionnaire Step 1 of 14 7% My Name is* First Last My email is:* I am a*Select one..MaleFemaleWhat is your age?*Select one..212223242526272829303132333435363738394041424344454647484950515253545556575859606162636465666768697071727374757677787980818283848586878889909192939495Above 95 years oldHow tall are you?*Select one..Less than 5'5'5' 1"5' 2"5' 3"5' 4"5' 5"5' 6"5' 7"5' 8"5' 9"5' 10"5' 11"6'6' 1"6' 2"6' 3"6' 4"6' 5"6' 6"6' 7"6' 8"6' 9"6' 10"6' 11"7'More than 7'How much do you weigh?*Evaluate the following statements as true or false:If I were to face an attack by a much larger armed man, I am not confident I would be able to defend myself with my bare hands.*Select oneTrueFalse Are you over 40 years old?*Select one..TrueFalseEvaluate the following statements as true or false:I am not nearly as strong or as fit as I was in my youth.*Select one..TrueFalseIf I were to face an attack by a much younger assailant, I am not confident I would be able to adequately defend myself in hand to hand combat.*Select one..TrueFalseAre you over 60 years old?*Select one..YesNoEvaluate the following statements as true or false:My advanced age has also left me in a much weaker state. If I were to be overtaken by an attacker and shoved to the ground, the damage alone would be devastating and even deadly for me.*Select one..TrueFalse Are you self-employed or do you own a business?*Select one..YesNoEvaluate the following statements as true or false:Sometimes my work requires me to travel to areas of town where there is known to be high crime rates, including crimes of opportunity like armed robbery.*Select one..TrueFalseDuring my normal course of business, I often must carry very expensive tools and equipment on my person and in my vehicle.*Select one..TrueFalseI also sometimes carry large amounts of cash during bank deposits. This makes me a high-value target for thieves and therefore more likely to face an attack.*Select one..TrueFalseIf an attacker were to take my tools or money, it would be devastating for my business and my family.*Select one..TrueFalseI feel that carrying a firearm would put me at an advantage in the case of an attempted robbery.*Select one..TrueFalse Are you applying to carry your firearm while at work?*Select one..YesNoWhat is the name of your employer?* Evaluate the following statements as true or false:The nature of my work sometimes puts me in bad areas of town where there is dangerous crime.*Select one..TrueFalseI often see gang members, homeless persons or people with erratic behavior come in and out of our store or around our worksite.*Select one..TrueFalseI have experienced incidents at work in the past that I felt my safety was in danger.*Select one..TrueFalseTell us about the incident:*I have spoken with my employer, and the owner has agreed to allow me to carry a concealed firearm at work.*Select one..TrueFalseI have attached a letter from the owner with my packet.*Select one..TrueFalse Evaluate the following statements as true or false:I have a significant other.*Select one..TrueFalseI have young children.*Select one..TrueFalseHow many children do you have under the age of 18?*Select one..0123456789101112131415More than 15We sometimes spend time out as a family, where I feel it is my responsibility to protect my family from harm.*Select one..TrueFalseWith the rise in crime in Bakersfield (and California as a whole), I feel carrying a firearm would help me better protect myself and my family.*Select one..TrueFalse Are you a disabled person?*Select one..YesNoWould your disabilities potentially negatively impact your ability to defend yourself?*Select one..YesNoPlease list your disabilities that would impact your ability to effectively defend yourself:Evaluate the following statements as true or false:My disability or disabilities negatively impact my ability to defend myself against an attacker.*Select one..TrueFalseThey also cause me to be more susceptible to injury.Select one..TrueFalseDue to my disabilities, I feel that I would better be able to defend myself against an attack in public if I were able to carry a firearm.*Select one..TrueFalse I have been the victim of attack in the past.*Select one..TrueFalseTell us about the incident(s):*Evaluate the following statements as true or false:The incident has caused me to feel unsafe and vulnerable when going out in public.*Select one..TrueFalseI believe there’s still a chance my attacker may strike again.*Select one..TrueFalseI currently have a restraining order against the attacker, but I understand that is just a piece of paper.*Select one..TrueFalseI would feel much more confident in my ability to protect myself and my loved ones if I were able to carry a firearm with me at all times.*Select one..TrueFalse Evaluate the following statements as true or false:Do you sometimes travel to or through remote locations?*Select one..TrueFalseI sometimes travel to and through remote locations for the purposes of:* Camping Fishing Hunting Visiting Family Hiking General Travel and Site Seeing Select all applicable reasonsDuring my travels, I often lose cell phone reception, and am unable to make or receive phone calls.*Select one..TrueFalseThe inability to make or receive phone calls makes it impossible to contact law enforcement in the case of an emergency.*Select one..TrueFalseI believe it would greatly improve my ability to defend myself against an attack if I was able to carry a firearm.*Select one..TrueFalse Do you have law enforcement experience?*Select one..YesNoWhat state did you serve in?* Which agency did you serve with* What was your job title?* Which year did you start serving as LEO*Which year did you stop serving as LEO*Evaluate the following statements as true or false:In my capacity as a law enforcement officer, I had specialized training in the use of force and de-escalation techniques.*Select one..TrueFalseI believe this training and experience helps show that I will remain a diligent and responsible concealed carry permit holder.*Select one..TrueFalseI never had any issues related to the possession or use of firearms during my career.*Select one..TrueFalse Did you serve in the US armed forces?*YesNoWhich Branch of Armed Forces did you serve in?* What was the length of your service (in years)?*Select one..1234567891011121314151617181920+Evaluate the following statements as true or false:During my time in service, I spent time learning how to safely and effectively use firearms to protect myself and others.*TrueFalseI never had any firearm-related safety incidents while serving, despite years of working with and around them.*Select one..TrueFalse Do you have any training in hand to hand combat?*Select one..YesNoHow many years of training do you have?*Select one..1234567891011121314151617181920+Evaluate the following statements as true or false:My training in martial arts has taught me discipline, as well as instilled a philosophy of de-escalation whenever and wherever possible.Select one..TrueFalseBased on my training and experience, I know my skills in hand to hand combat would not be effective against a knife or a gun attack.*Select one..TrueFalseI feel that a firearm would give me the necessary advantage I would need if de-escalation techniques did not work and I had to defend my life or the lives of my family.*Select one..TrueFalse Have you been issued a CCW in the past?*Select one..YesNoWhat County and State was the CCW Issued in?* Evaluate the following statements as true or false:I have attended professional firearms training courses in the past.*Select one..TrueFalseList the courses you have attended here (one line each):*Through my training, I have accumulated skills certifications.*TrueFalseList your certifications here (one line each):*How many years have you owned firearms safely without incident?*Select one..12345more than 5 yearsI plan to continue my professional firearms education beyond the initial CCW requirements and maintain a high level of competence with my firearms.*Select one..TrueFalse There has been an uptick in violence throughout the country in the last few years. Riots have become commonplace dating all the way back to 2016. In fact, in mid-2020 we experienced violent riots here in Downtown Bakersfield. Businesses were vandalized and people were injured. As a resident of Bakersfield who sometimes travels Downtown for business and shopping, I feel extremely unsafe. The threat of being attacked by multiple people at one time is very serious, and I am confident I would not be able to adequately defend myself against multiple attackers with just my bare hands or even a knife. I do not believe these social issues are going to subside anytime soon. In fact, I fear there will likely be more riots and violence as time goes on.*Select one..TrueFalseCAPTCHANameThis field is for validation purposes and should be left unchanged. Δ