NAME AND ADDRESS

Application Date:

Are you 21 years of age or older?
YesNo

POSITION DESIRED

Position applied for:
VolunteerFull TimePart Time
Have you applied with us before?
YesNo
Our hours of operations may include weekends and holidays.
Are you available to work any schedule necessary to help us meet our objectives:
YesNo

Are you presently employed?YesNo
If yes, may we contact your present employer?
YesNo

Do you have reliable transportation to get to work each day?
YesNo

To your knowledge, have you ever been employed by this Company or a subsidiary?
YesNo

Referral Source:
Walk-InOur WebsiteAdvertisementEmployee ReferralOther

EDUCATION

THE FOLLOWING INFORMATION WILL BE USED ONLY TO THE EXTENT RELEVANT TO THE POSITION FOR WHICH YOU APPLY.

Do you have a high school diploma or GED?
YesNo
Did you earn a degree from college?
YesNo

LICENSES

THE FOLLOWING INFORMATION WILL BE USED ONLY TO THE EXTENT RELEVANT TO THE POSITION FOR WHICH YOU APPLY.

Do you have a Driver’s License?YesNo

Do you have a Class D License?YesNo

Do you have a Class G License?YesNo

Do you have a Class M, MB, K or PI License? YesNo

Do you have any other Security License or Certification? YesNo

Have you ever been convicted of, or pled guilty or “no contest” (nolo contendere) to a misdemeanor or felony, including sexrelated and/or child abuse-related offenses? Do not include minor traffic infractions for which you never appeared in court or convictions or pleas which have been deemed sealed, annulled, or expunged by law.
YesNo

If yes, provide details concerning the type of crime, the date of the conviction or plea, the penalty imposed, and any other circumstances you deem relevant to a full understanding of what occurred. Attach additional sheets if necessary.
NOTE: Answering “YES” to this question is not an automatic bar to employment. Factor such as age at the time of the offense, seriousness, and nature of the violation, relatedness to the job sought, the amount of time which has passed since the event occurred, and evidence of rehabilitation will be taken into account. However, please be advised that a misstatement or comission in answering this question may be grounds for disciplinary action, including discharge.

Have you been arrested or charged with any misdemeanor or felony, including sex-related and/or child abuse-related offenses, not disclosed above for which you are out on bail or free on your own recognizance pending disposition or trial? Do not include minor traffic infractions for which no court appearance is necessary.
YesNo
If yes, provide details concerning the type of crime, the date of the conviction or plea, the penalty imposed, and any other circumstances you deem relevant to a full understanding of what occurred. Attach additional sheets if necessary.
NOTE: Answering “YES” to this question is not an automatic bar to employment. Factor such as age at the time of the offense, seriousness, and nature of the violation, relatedness to the job sought, the amount of time which has passed since the event occurred, and evidence of rehabilitation will be taken into account. However, please be advised that a misstatement or omission in answering this question may be grounds for disciplinary action, including discharge.

Have you ever been sued in a civil action with regard to the death of or personal injury or intentional damage to any person or to
any property?
YesNo

If yes, give details concerning the nature of the claims and defenses raised by the parties, the outcome of the action (e.g. settlement, jury verdict, or other disposition), and any other circumstances you deem relevant to a full understanding of what occurred. Attach additional sheets if necessary

Are you a citizen or lawful resident of the United States entitled to accept employment in this country?
YesNo

Are you currently engaged in using illegal drugs?
YesNo

WORK HISTORY

Have you ever been in the military?
YesNo

1

List all employment, including military, beginning with your present or last job held. If you need additional space, continue on a plain sheet of paper and attach it to this application.

2

3

Have you ever been dismissed or asked to resign from employment?
YesNo

PROFESSIONAL REFERENCES

Please list the names, addresses, and phone numbers of 4 people who are not related to you:

UNDERSTANDING AND AGREEMENTS