Name
Social Security Number
LAST FIRST
MIDDLE
Present Address How long at this address?
City State
Zip code
Phone
Position applied for
Salary Expected
PA Drivers License Number
EXP Date
Are you interested in
Full Time
Part Time Work
1st. 2nd.
3rd.
Shift?
Available for weekends? YES
NO
Are you a citizen of the United States?
YES
NO
I understand that a background investigation will be
conducted as required because the within application is filed for the
purpose of submitting an application of employment as a security person.
Accordingly, I voluntary consent to answer the following questions:
Have you ever been convicted of a crime? YES
NO
If Yes, Please list below:
DATE PLACE
CHARGE DETAILED
DESCRIPTION
Give the name of three persons whom you have known for at
least 5 (five) years.
Do not list relatives, previous employers, or clergy.
All references must be complete and WILL BE
checked.
NAME
ADDRESS
PHONE#
1
2
3
EDUCATION
Name of school
City/State Degree/Diploma
Course of study
High School
College
Other
Are you presently certified to carry a lethal weapon in any
state? YES
NO
If so, exp. date and which state?
Note: This refers to certification under Lethal Weapons
Training Act to carry a firearm for employment purposes.
MILITARY STATUS
If Veteran-supply copy of DD-214
If so, did your military experiences have any relationship
to the position for which you have applied?
EMPLOYMENT HISTORY
Give a complete employment history starting with your
present or last employer. Dates should include month and year; any periods
of unemployment MUST be explained.