Employment FormFirst NameMiddle NameLast NameCurrent AddressDates Lived HerePrevious Address (if less if resided less than 2 years)Date of Birth Other Names Used (including maiden name)Years Used Place of Birth CountyStateCountrySocial Security NumberDriver's LicenseStateStateAre you a citizen of the United States: YES or NO If no, are you authorized to work in the U.S YES or NO Have you ever been convicted of a felony YES or NOIf YES, please explainName of High school: Address:Attended Dates: From__ / to__Did you graduate: YES or NODegree:Name of College (if applicable)Address:Attended Dates: From__ / to__Did you graduate: YES or NODegree:Other specialty schools, degree’s please list belowName {Please list two References}RelationshipYears knownAddress NameRelationshipYears knownAddress 1. Do you have a Valid Concealed Pistol License? YES/NOIf YES License #2. Have you had a driver’s license is another state? YES/NO 3. Do you have any pending litigation/lawsuits against you? YES/NO 4. Have you been terminated or asked to resign from any employment YES/NO 5. Have you ever been convicted of a misdemeanor or felony YES/NO 6. Have you ever had a warrant issued against you? YES/NO 7. Have you ever been involved in an automobile accident YES/NO 8. Are you aware that Security Squad is a Drug Free environment, any drugs other than prescribed will result in the immediate termination of employment. YES/NO List 3 years of previous employment {COMPANY}PhoneAddress SupervisorJob TitleStarting Salary $ Ending Salary $ResponsibilitiesFrom:_______ To_______Reason for LeavingMay we contact your previous supervisor for a reference: YES/NO CompanyPhoneAddress SupervisorJob TitleStarting Salary $ Ending Salary $ResponsibilitiesFrom:_______ To_______Reason for LeavingMay we contact your previous supervisor for a reference: YES/NO CompanyPhoneAddress SupervisorJob TitleStarting Salary $ Ending Salary $ResponsibilitiesFrom:_______ To_______Reason for LeavingMay we contact your previous supervisor for a reference: YES/NO I do hereby authorize verification of all information in my employment application from all sources of employment, education, motor vehicle, financial history, criminal history, personal character, and worker's compensation records in accordance with ADA, labor and wage records, etc. or any part thereof, and authorize any duly authorized agent of Security Squad to obtain, whether the said records are public or private, and including those which may be deemed to be privileged or confidential in nature and I release all persons from liability on account of such disclosures. Information appearing on this Authorization will be used exclusively by Security Squad for identification purposes and for the release information which will be considered in determining any suitability for employment. I certify that I have made true, correct, and complete answers and statements on my employment application, any supplements to it and in any interview in the knowledge that they will be relied upon in considering my application for employment. I authorize Security Squad to utilize third party background companies, if utilized to complete the background check. I agree to provide additional information that may be requested to process my employment application. I authorize without reservation, any party or agency contacted by Security Squad to furnish the above-mentioned information. This authorization is valid during the course of my employment to the extent permitted by law. I hereby authorize you to contact my current employer for Employment and Reference Verifications (This will authorize immediate inquiries to the Human Resources Department and to any listed supervisors or references in the Employment/Reference Section of your application.) I have the right to make a request to Security Squad, upon proper identification, to request the nature and substance of all information in its files on me at the time of my request, including sources of information, and the recipients of any reports on me which Security Squad has previously furnished within the two-year period preceding my request. I understand and agree that any omission, false statement, misleading statement, or answer made by me on my application or any supplements to it and in any interviews will be sufficient grounds for rejection of employment and my discharge after employment. Submit Form
