Position Applying For |
| *Applying For:
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|
*Last Name |
*First Name |
Middle Name |
*Address |
*City |
*State |
*Zip |
Home Phone |
Work Phone |
Mobile Phone |
| Best time to contact you
|
| Email
|
| Are you over the age of 18?
Yes
No Date of Birth:
|
Eligibility: Do you have the legal
right to permanent employment in the United States:
U.S.
Citizenship
Permanent Resident Status
Other
(please explain, include any current work authorization and
expiration dates)
|
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Do you have any relatives currently or formerly employed
by APSI?
Yes
No |
Have you ever worked for
APSI?
Yes
No
If yes, from (mo/yr)
to (mo/yr)
|
Do you possess a valid Driver's
License?
Do you possess a valid Guard Card?
In which state?
Class?
Endorsements?
|
List the number of traffic
convictions and the assigned points you have received for
any moving violations during the past 24 months:
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Is your license currently restricted
due to previous convictions? If so, how?
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| This section must be completed regardless of submitted resume.
Account for all periods of time including military service, related
volunteer experience, as well as any period of NON-EMPLOYMENT.
Indicate changes in job title under same employer as a
separate position. |
| Employer 1 or Non-employment |
| Employer Name:
Phone Number:
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| Employer Address:
|
| Job Title(s):
Hours per week:
|
| Employed from (mo/yr):
Employed to (blank if present):
|
| Starting Salary:
Ending
Salary:
|
Duties and Responsibilities:
|
| Name/Title of Supervisor:
|
| Reason for leaving:
|
|
| Employer 2 or Non-employment |
| Employer Name:
Phone Number:
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| Employer Address:
|
| Job Title(s):
Hours per week:
|
| Employed from (mo/yr):
Employed to (blank if present):
|
| Starting Salary:
Ending
Salary:
|
Duties and Responsibilities:
|
| Name/Title of Supervisor:
|
| Reason for leaving:
|
|
| Employer 3 or Non-employment |
| Employer Name:
Phone Number:
|
| Employer Address:
|
| Job Title(s):
Hours per week:
|
| Employed from (mo/yr):
Employed to (blank if present):
|
| Starting Salary:
Ending
Salary:
|
Duties and Responsibilities:
|
| Name/Title of Supervisor:
|
| Reason for leaving:
|
|
| Employer 4 or Non-employment |
| Employer Name:
Phone Number:
|
| Employer Address:
|
| Job Title(s):
Hours per week:
|
| Employed from (mo/yr):
Employed to (blank if present):
|
| Starting Salary:
Ending
Salary:
|
Duties and Responsibilities:
|
| Name/Title of Supervisor:
|
| Reason for leaving:
|
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| Employer 5 or Non-employment |
| Employer Name:
Phone Number:
|
| Employer Address:
|
| Job Title(s):
Hours per week:
|
| Employed from (mo/yr):
Employed to (blank if present):
|
| Starting Salary:
Ending
Salary:
|
Duties and Responsibilities:
|
| Name/Title of Supervisor:
|
| Reason for leaving:
|
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| Education |
| Have you graduated from high school
or received a high school equivalent diploma?
|
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| Post-High School Education |
|
| Certifications |
Describe any education or training
not covered above (i.e. vocational training, licenses, professional
memberships, internships, etc.) that is relevant to the job you are
applying for:
|
| Bilingual Skills |
Languages other than English |
Speaking
(Choose One) |
Reading
(Chose One) |
Understanding
(Chose One) |
Writing
(Chose One) |
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| Technical Skills |
| Typing/keyboarding
wpm |
|
10-key
Cash Register |
|
Word
Excel
Access
Power point
Front Page
WordPerfect |
|
| How did you hear about this
position: |
|
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| Conviction Record (Required
from ALL Applicants) |
| Answer this section truthfully, including all offenses of which you
were convicted or pleaded no contest. Have you ever been convicted
of a MISDEMEANOR or FELONY other
than minor traffic violations and/or placed on probation, fined, or
given a suspended or deferred sentence in court? Include any
convictions by military trial and any criminal charges for which you
are awaiting trial. List all cases other than minor traffic
violations. Driving under the influence, careless, reckless, or
hit-and-run driving are not minor traffic violations. PLEASE
NOTE: A full disclosure by you is to your advantage, as
your record does not necessarily disqualify you for employment.
Factors such as, but not limited to, age at time of offense(s) and
recency of offense(s) as well as the relationship between the
offense(s) and the job(s) for which you apply may be taken into
account. Human Resources routinely verifies conviction, driving and
other information listed on this application. If you do not respond
correctly, or if you commit errors of omission of fact, either
intentionally or unintentionally, you may be ineligible for American
Patriot employment.
*Have you ever been convicted of a violation
or any ordinance or law other than a minor traffic violation?
No
Yes
If yes, provide the information
requested below for each offense.
DO NOT LIST ARRESTS - ONLY CONVICTIONS. |
| Offense
|
Offense
|
Offense
|
| Date
|
Date
|
Date
|
| Place
|
Place
|
Place
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| Sentence/Fine
|
Sentence/Fine
|
Sentence/Fine
|
| YOUR SIGNATURE IS REQUIRED prior to your selection
for a position with American Patriot Security, Inc.. Signature will be required
for application submitted electronically at the time of job
interview or job offer.
Employment Application Certification
I hereby certify that all of the facts and information listed on
this employment application are true and complete. I understand that
any false, incomplete or misleading information given by me on this
application may be sufficient cause for rejection of this
application. I also understand and agree that any such false,
incomplete, or misleading information given by me on this
application and subsequently discovered after I am employed may
result in my dismissal.
I hereby authorize
APSI to investigate all
statements contained in this application. I authorize the references
and previous employers listed to give APSI all facts, opinions
and evaluations concerning my previous employment, and any other
information they may have, personal or otherwise, and I release all
such parties from any liability which may allegedly arise from
furnishing such information to APSI, including, but not limited
to, any liability for defamation or invasion of privacy.
I understand that, if I am offered employment,
I will be required to serve a probationary period and that my
continued employment is conditional based upon my performance.
I also understand that, if I am given an offer
of employment or a post employment promotion, it may be conditioned
on satisfactory results of a background investigation, pre-placement
physical, physical agility skill testing, substance screen, and a
APSI post-employment medical examination or inquiry.
I CERTIFY THAT I HAVE READ,
UNDERSTAND AND AGREE WITH THE ABOVE AND THAT MY FAILURE TO SIGN
BELOW WILL NULLIFY MY CONSIDERATION FOR EMPLOYMENT. |
| Date
|
*CHECK HERE
TO CERTIFY:
|
|
| Equal Employment Opportunity |
| |
| Thank you for completing this
application. |
