APPLICATION FOR EMPLOYMENT First Name * Middle Initial Last Name * Date * Street Address * Apartment / Unit City * State * Zip Code * Phone * Email * Position Applied For Position Applied For Armed Unarmed Other Desired Salary ($) Date of Birth Social Security # Driver's License # License State License Expiration Guard Card # Guard Card Expiration Firearms Permit # Firearms Permit Expiration Type of Employment Desired Full-TimePart-TimeTemporary Date & Days Available to Work Questions Would you be available to work overtime if required? YesNo Can you travel if required by post? YesNo Have you ever been employed by our organization before? YesNo Can you submit proof of identity and authorization to work in USA? YesNo If you are under 18, can you furnish a work permit? YesNo How did you hear about us? Source Emergency Contact Primary Emergency Contact Emergency Contact 1 Name Relationship Phone Emergency Contact 2 Name Relationship Phone Other Skills & Qualifications Please summarize any job-related training, skills, certificates, licenses or other qualifications. Education School Name & Location Course of Study Years Completed Graduated Degree Received High School YesNo College YesNo Business / Trade / Other YesNo Professional References We may contact your references for verification purposes. Reference 1 Name Relationship Address Phone Number Email Reference 2 Name Relationship Address Phone Number Email Employment History Please list all present and past employment, beginning with your most recent employer. Last / Present Employer Employer Name Starting Hourly Wage Address Last Hourly Wage City Type of Business Supervisor Telephone Job Duties Start Date End Date Reason for Leaving Status ResignedFiredLaid Off Employer #2 Employer Name Starting Hourly Wage Address Last Hourly Wage City Type of Business Supervisor Telephone Job Duties Start Date End Date Reason for Leaving Status ResignedFiredLaid Off Employer #3 Employer Name Starting Hourly Wage Address Last Hourly Wage City Type of Business Supervisor Telephone Job Duties Start Date End Date Reason for Leaving Status ResignedFiredLaid Off Employer #4 Employer Name Starting Hourly Wage Address Last Hourly Wage City Type of Business Supervisor Telephone Job Duties Start Date End Date Reason for Leaving Status ResignedFiredLaid Off Military History Have you ever served in the Armed Forces? YesNo Branch of Service Dates of Service Type of Discharge Reserve Status Can you provide DD-214? YesNo If Active, Provide ID Declaration I certify that the information provided in this employment application is true and complete to the best of my knowledge. I understand that false or misleading information may result in the rejection of my application or termination of employment if hired. I certify that all information provided above is true and correct. Applicant Signature (Type Full Name) Date & Time