Form fields are not supported in RPE. What I mean here is, clickable check box isn’t supported. However, pictogram of a check box can be achieved via symbols in Word.
Thanks to Dragos for the solution.
The template looks like the below screenshot. Get the template here.

Checked and unchecked in Word document as below.

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Author: Kumaraswamy M
Kumar is an architect for Rational Publishing Engine. He has been with the product for more than 4 years and has been involved in many releases of RPE. His expertise are in Web application development and API design. He loves going on a long ride on bike and conquering peaks during weekend treks.
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How do I import the Windings2 font?
I’ve this font in Windows 7 with MS Word 2010 installation. Otherwise, you should find them at https://www.microsoft.com/typography/fonts/font.aspx?FMID=1077.
Installing / Uninstalling a new font – http://windows.microsoft.com/en-in/windows-vista/install-or-uninstall-fonts
I got it. Didn’t realize you could just type a font into the font box.