Security Application Form

Synergy Elite Security Application Form
General Information
Applicant Name*

First NameLast Name
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Date of Birth*

MonthDayYear
Date
Gender*
Social Security Number*
Are you:

SingleMarriedSeparatedDivorcedOther
What hours are you available for work?
D Security License #*
G Security License #*
Salary Desired
What days are you available for work?

SundayMondayTuesdayWednesdayThursdayFridaySaturday
What shift are you available for work?

AMPM
What shift are you available for work?
Are you 18 years of age or older?*

YESNO
Are you a U.S. citizen or approved to work in the United States?*

YESNO
Will you consent to a mandatory controlled substance test?*

YESNO
Do you have any friends, relatives, or acquaintances working for Synergy Elite Security?

YESNO
Are you able to perform the essential functions of this position, with or without special accommodations?*

YESNO
Job Skills/Qualifications
Background Information
Have you ever worked in law enforcement ?*

YesNo
If YES, what agency?*
Are you a member of the Armed Services?*

YESNO
What branch of the military did you enlist?
What was your military rank when discharged?
What military skills do you possess that would be an asset for this position?
Have you ever been charged with a crime, been convicted of it, or pleaded guilty to it?*

YesNo
If so, please describe.
Have you ever been treated for a psychiatric disorder or are you currently taking antidepressants?*

YesNo
Do you have any formal handgun training?*

YesNo
Do you have reliable transportation?*

YESNO
Employer 1
Employer 1 *
Job Title*
Date Employed (START)*

MonthDayYear
Date
Date Employed (END)- If still employed leave blank

MonthDayYear
Date
Pay Rate $
Employer Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Supervisors Name*

First NameLast Name
Employer Telephone*
Please enter a valid phone number.
Duties Performed *
Reason of Leaving*
Can we contact your previous employer?*

YESNO
Reference Name
Reference Name

First NameLast Name
Title
Phone Number
Please enter a valid phone number.
Relationship
Company
Please upload a copy of your valid driver's license.*

Cancelof
Please upload a copy of your valid D security license
File Upload*

Cancelof
Please upload a copy of your valid permit to carry arms.
File Upload

Cancelof
Are your security licenses up-to-date / valid?*

Yes, my D Security License is validNO, my D Security License has expired-RenewingYes, my G Security License is validNO, my G Security License has expired - RenewingI have a temporary security license blue cardBOTH D & G LICENSES ARE VALID
What motivates you to join the security team?
Date*

MonthDayYear
Date
Applicant Signature*

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AT-WILL EMPLOYMENT
The relationship between you and the Synergy Elite Security Services, is referred to as "employment at will". This means that your employment can be terminated at any time for any reason, with or without cause, with our without notice, by you or the Synergy Elite Security Services. No representative ofSynergy Elite Security Services, has authority to enter into an agreement contrary to the foregoing "employment at will" relationship. You understand that your employment is "at will", and that you acknowledge that no oral or written statements or representations regarding your employment can alter your at-will employment status, expect for a written statement signed by you and either our Executive Vice-President/Chief Operations officer or the Company's President.
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Synergy Elite Security Application Form

General Information

Background Information

Employer 1

Reference Name