Protect Security Employment Application

EMPLOYMENT APPLICATION

AN EQUAL OPPORTUNITY EMPLOYER

Section 1 - Personal Information
Application Date*

MonthDayYear
Date
Full Name*

First NameMiddle NameLast Name
Date of Birth*

MonthDayYear
Social Security Number*
Social Security No.
Present Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Cell Number*
E-mail*
myemail@example.com
Are you an US Citizen?*

YesNo

Section 2 - Emergency Contact

Emergency Contact

	Name	Address	Phone Number	Relationship
1.
2.
3.

Are you under indictment, ever been convicted of or pleaded guilty to a felony?*

YesNo
If yes, please describe the circumstances in detail listing date(s) of arrest/indictment, jurisdictions, date of conviction(s), etc. Use additional sheets if necessary:
If hired, would you need any special accommodations?*

YesNo
If yes, please explain.
Are you currently vaccinated for COVID-19?*

YesNo

Section 3 - Military Service
Have you ever served in the U.S. Military?*

YesNo
Have you ever served in the National Guard?*

YesNo
Branch:
Branch
Rank:
Rank
Status of Discharge:
Status of Discharge

Section 4 - Education

Enter your education history below*

	Name of School	Address	Graduated (Yes/No)	Course of Study/Major
High School
College
Trade/Technical School
Other

Section 5 - Employment (1)
How did you hear about us?
Are you at least 21 years or older?*

YesNo
Have you ever been employed by another security company?*

YesNo
Have you ever been employed by Protect Security, LLC?*

YesNo
If yes, please specify dates:

MonthDayYear
Start
MonthDayYear
End
Do you have family, friends or acquaintances that are currently employed by Protect Security?*

YesNo

If yes, state name and relationship

	Name	Relationship
1.
2

Do you have your own vehicle?*

YesNo
If no, do you have reliable transportation?*

YesNo
Do you currently possess, or have you ever possessed a certification as an armed or unarmed security officer or other certifications relevant to the position of Security Officer?*

YesNo
If yes, please provide license number and date of expiration:

Section 6 - Employment (2)
Are you currently working?*

YesNo
Desired Position:
Desired Position
Desired Pay Rate:
Desired Pay Rate
I desire to work:*

Full-TimePart-Time
Available Start Date:*

MonthDayYear
Date

Type a Availability: (Check ALL available boxes below.)

	1st Shift	2nd Shift	3rd Shift	Open availability
Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday

Section 7 - Employment History
Employment History

List your last three (3) employers, assignments, or volunteer activities, starting with the most recent, including military experience. Explain any gaps in employment in the comments section below.
Employer:
Address:
Dates Employed:
Job Title:
Supervisor Name:
Phone:
Rate of Pay:
Description of Duties:
Reason For Leaving:
May We Contact This Employer?

YesNo
Employer:
Address:
Dates Employed:
Job Title:
Supervisor Name:
Phone:
Rate of Pay:
Description of Duties:
Reason For Leaving:
May We Contact This Employer?

YesNo
Employer:
Address:
Dates Employed:
Job Title:
Supervisor Name:
Phone:
Rate of Pay:
Description of Duties:
Reason For Leaving:
May We Contact This Employer?

YesNo

Section 8 - References
References

Give the names and contact information for three (3) persons not related to you, who have known you for at least one (1) year.

References

	Name	Address	Telephone	Occupation	Years Known
1
2
3

Section 10 - Submit Application
PLEASE READ CAREFULLY BEFORE SIGNING.

I certify that all the information submitted by me on this application is true and complete. I understand that if any false information, omissions, or misrepresentations are discovered, my application may be rejected, and, if I am employed, my employment may be terminated at any time. In consideration of my employment, I agree to conform to the company’s rules, regulations, and Supervisor’s directions. I agree that my employment is at-will, and that my employment and compensation can be terminated, with or without cause, and with or without notice, at either my or the company’s option. I understand that if I am offered employment, or if I am re-employed pursuant to this application, it will be on a 90-day introductory period. I also understand and agree that the terms and conditions of my employment may be changed, with or without cause, and with or without notice, at any time by the company. I understand that no company representative, other than the President, and then only in writing, has any authority to enter into any agreement for employment for any specific period of time or to make any agreement contrary to the forgoing. I further authorize all work-related verifications of employment, education, training, or other work-related information, as well as credit or criminal records checking. I authorize all this information to be provided to the company or their agent and release them from any liability which might be claimed. If required, I agree to fully participate and complete a pre- or post-employment drug screening as authorized by applicable law.
Signature*

Clear
Application Completed*

MonthDayYear
Date
NOTICE TO ALL PARTICIPANTS DRUG SCREENING REQUIREMENTS

Effective immediately, the Company will begin implementation of a drug testing program for applicants. This program will involve testing of the potential employee of the Company. As part of the employment process and after a conditional offer of employment has been extended, potential employees will be required to cooperate in the collection of a urine specimen administered by qualified medical or laboratory personnel designated by the company. Testing of the specimen will be conducted by a company-approved biomedical testing laboratory with demonstrated expertise and procedures to ensure proper handling and reporting of results. In the event of a confirmed positive test result, the conditional offer of employment will be revoked, and the hiring process will be terminated immediately.
APPLICANT INFORMED CONSENT TO DRUG TESTING AND RELEASE OF LIABILITY AND MEDICAL INFORMATION

I understand and agree that I am required, as a potential employee, to submit a sample of my urine for chemical testing as a part of my pre-employment screening. It is understood that the urine sample will be taken in the offices of a company designated laboratory and analyzed by qualified medical or laboratory personnel. Further, I understand this analysis will be used to determine the presence, if any, of non-prescribed, unauthorized, or prohibited controlled substances in my urine. I freely and voluntarily consent to this request for a urine specimen. I hereby release and hold harmless the Company, the laboratory, the property owner and their respective employees, agents, contractors, officers, directors, and affiliates from any liability whatsoever arising from the request for a urine sample, the testing of the urine sample, and any decisions made on the basis of analysis. I further freely voluntarily authorize the company-designated laboratory to release to the Company all test results of the drug screening urine test as permitted by law. I understand that a document chain of specimen custody will be made to ensure the identity and integrity of my urine sample throughout the collection and testing process.
APPLICANT INFORMED CONSENT TO DRUG TESTING AND RELEASE OF LIABILITY AND MEDICAL INFORMATION

I understand and agree that I am required, as a potential employee, to submit a sample of my urine for chemical testing as a part of my pre-employment screening. It is understood that the urine sample will be taken in the offices of a company designated laboratory and analyzed by qualified medical or laboratory personnel. Further, I understand this analysis will be used to determine the presence, if any, of non-prescribed, unauthorized, or prohibited controlled substances in my urine. I freely and voluntarily consent to this request for a urine specimen. I hereby release and hold harmless the Company, the laboratory, the property owner and their respective employees, agents, contractors, officers, directors, and affiliates from any liability whatsoever arising from the request for a urine sample, the testing of the urine sample, and any decisions made on the basis of analysis. I further freely voluntarily authorize the company-designated laboratory to release to the Company all test results of the drug screening urine test as permitted by law.

I understand that a document chain of specimen custody will be made to ensure the identity and integrity of my urine sample throughout the collection and testing process.
Signature of Applicant*

Clear
Date*

MonthDayYear
Date
Social Security Number*
Witness

Clear
AUTHORIZATION FOR RELEASE OF INFORMATION

I hereby authorize Protect Security, LLC and/or any of its designated agents and representatives to conduct a comprehensive review of my background through a criminal history, driving history, consumer report/investigative consumer report to be generated for employment, promotion, reassignment, or retention as an employee. I understand that
the scope of these reports may include but are not limited to the following areas: verification of social security number, current and previous residences, employment history including all personnel files, education, character references, credit history and reports, criminal history records from any criminal justice agency in any or all federal, state county jurisdictions, motor vehicle records to include traffic citations and registration and any other public records.

I authorize the complete release of these records or data pertaining to me which an individual, company, firm, corporation, or public agency may have. I hereby authorize and request any present or former employer, school, police department, financial institution or other persons having personal knowledge of me, to furnish bearer with all information in their possession regarding me in connection with an application for employment. This authorization and consent shall be valid in original, fax, or copy form.

I hereby release Protect Security, LLC and/or any of its agents, officials, representatives, or assigned agencies, including officers, employees, or related personnel both individually and collectively, from all liability for damages of whatever kind, which may at any time, result to me because of compliance with this authorization. Information on this application and results of the background investigation will be maintained in confidence in accordance with company hiring practices.
Name

First NameMiddle InitialLast NameMaiden/Former Name
Current Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Social Security Number*
Date of Birth*

MonthDayYear
Driver License Number*
State of Issue*
Signature*

Clear
Date*

MonthDayYear
Date
I understand that the company will provide me with a copy of any such report as pursuant to the federal Fair Credit Reporting Act or I may request a copy of any report that is prepared, along with the name and address of the reporting agency that produced the report regarding me and “A Summary of Your Rights under the Fair Credit Reporting Act.”

*I understand that I must provide my date of birth to adequately complete said screening and acknowledge that my date of birth will not affect any hiring decisions.
Should be Empty:

EMPLOYMENT APPLICATION

Employment History

References

Protect Security Assessment Test

APPLICANT INFORMED CONSENT TO DRUG TESTING AND RELEASE OF LIABILITY AND MEDICAL INFORMATION