Employment Application

How did you hear about our company? (Please check all that apply.)

Newspaper	Job Fair	Referred
Website	Work Program	Walk-in
Friend	Employee	Other

Applying for:

Full-Time

Part-Time

Temporary

Special Event

Other

Contact Information:

First Name:

Middle Initial:

Last Name:

Home Phone:

Mobile Phone:

Email:

Address Information:

Address:

Apartment/Room #:

City:

State:

Zip Code:

Qualifications:

License Form:	Yes:	No:	State:	License No.:	Expiration Date:
Driver's License
Guard Card
Firearms Permit
Baton Perimt

Certification:	Yes:	No:	List all additional license's and certifications below:
First Aid
CPR & AED
Pepper Spray
Stun Gun

Have you ever been employed with American Patriot Security, Inc. in the past?	Yes		No		If yes, when:
Has a friend or relative ever been employed with American Patriot Security, Inc.?	Yes		No		If yes, when:

Education:

School Name:	Graduated?:			Primary Subject Taken:	Dates Attended:
	Yes	No	In Progress
	Yes	No	In Progress
	Yes	No	In Progress

Please list all certifications, awards, achievemnets, etc. earned below:

Military Experience:

Branch:	Specialty:	Honorably Discharged?
		Yes	No
		Yes	No
		Yes	No

Previous Employment:

Employer Information 1
Employer Name:
Address:
City:	State:	Zip Code:
Start Date:	End Date:
Start Wage:	End Wage:
Supervisor:	Title:
Description of your duties:

Reason for Leaving:

Employer Information 2
Employer Name:
Address:
City:	State:	Zip Code:
Start Date:	End Date:
Start Wage:	End Wage:
Supervisor:	Title:
Description of your duties:

Reason for Leaving:

Employer Information 3
Employer Name:
Address:
City:	State:	Zip Code:
Start Date:	End Date:
Start Wage:	End Wage:
Supervisor:	Title:
Description of your duties:

Reason for Leaving:

References:

Name:	Phone:	Relation:	Years Known:

Background:

Have you ever been convicted of a felony or misdemeanor?

Yes

I HEREBY CERTIFY that the above information is accurate, and that any falsification thereof is subject to rejection of my application and potential employement with American Patriot Security, Inc.

Certify: