Basin Patrol, LLC Employment Application

Name:*

First NameMiddle NameLast Name

Birth Date*

MonthDayYear

Phone Number:*

Area CodePhone Number

E-mail Address:

Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

How were you referred to us?*

When are you available to start work?

Employment desired.

Hourly rate desired. $ Per Hour

Upload Resume:

Upload a File

Have you ever been arrested?

YesNo

Have you ever been convicted of a crime?

YesNo

If Yes, explain number of conviction(s), nature of offense(s) leading to conviction(s), how recently such offense(s) was/were committed, sentence imposed, and if cleared on record.

Do you have a valid driver's license?

YesNo

Driver's License number

Have you had any accidents during the past 3 years?

YesNo

Have you had any moving violations during the past 3 years?

YesNo

Have you ever been in the armed forces?

YesNo

Do you carry a valid pocket card Level II of Level III with TXDPS?

Yes, Level II Non Commissioned OfficerYes, Level III Commissioned OfficerNo, either expired or not applied for in past

If YES Level II or Level III Please list registration numbers and expiration dates below.

1. Most Recent: Name of Employer

CompanySupervisor

Date of Last Employment with above company

MonthDayYear

Brief description of job title, duties and reason for leaving.

2: Name of Employer

CompanySupervisor

Date of Last Employment with above company

MonthDayYear

Brief description of job title, duties and reason for leaving.

Name:*

First NameLast Name

Phone Number*

Area CodePhone Number

Years Known:*

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Name:*

First NameLast Name

Phone Number*

Area CodePhone Number

Years Known:*

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

PLEASE READ CAREFULLY

APPLICATION FORM WAIVER

In exchange for the consideration of my placement application by Security Response Solutions, LLC(hereinafter called “the Company”), I agree that:

Neither the acceptance of this application nor the subsequent entry into any type of work relationship, either in the position applied for or any other position, and regardless of the contents of Associate handbooks, Policy and Procedures manuals, benefit plans, policy statements, and the like as they may exist from time to time, or other Company practices, shall serve to create an actual or implied contract of employment, or to confer any right to remain an Associate of Paradigm Security Services, Inc., or otherwise to change in any respect the employment-at-will relationship between it and the undersigned, and that relationship cannot be altered except by a written instrument signed by the President of the Company. Both the undersigned and Security Response Solutions, LLC may end the placement relationship at any time, without specified notice or reason. If placed, I understand that the Company may unilaterally change or revise their benefits, policies and procedures and such changes may include reduction in benefits.

I authorize investigation of all statements contained in this application. I understand that the misrepresentation or omission of facts called for is cause for dismissal at any time without any previous notice. I hereby give the Company permission to contact schools, previous employers (unless otherwise indicated), references, and others, and hereby release the Company from any liability as a result of such contract.

I also understand that (1) the Company has a drug and alcohol policy that provides for pre-placement testing as well as testing after placement; (2) consent to and compliance with such policy is a condition of my placement; and (3) continued placement is based on the successful passing of testing under such policy. I further understand that continued placement may be based on the successful passing of job-related physical examinations.
I understand that, in connection with the routine processing of your placement application, the Company may request from a consumer reporting agency an investigative consumer report including information as to my credit records, character, general reputation, personal characteristics, and mode of living. Upon written request from me, the Company, will provide me with additional information concerning the nature and scope of any such report requested by it, as required by the Fair Credit Reporting Act.

By submitting this form, you are stating that all entries are true and correct to the best of your knowledge, please type your full name in box below.

Thank you for completing this application form and for your interest in our business.

Your application will be reviewed and you will be contacted by a Security Response Solutions, LLC staff memeber.

Security Response Solutions Employment Opportunities

Security Response Solutions LLC Employment Application

Background Information

Work Experience

References

Reference 1

Reference 2