GOLDEN EMPIRE SECURITY JOB APPLICATION

References

List below three persons not related to you who have knowledge of your work performance within the last 3 years
Name & Telephone:
Address
City, State & Zip Code:
Occupation:
Number of Years Acquainted:
Name & Telephone:
Address:
City, State & Zip Code:
Occupation:
Number of Years Acquainted:
Name & Telephone:
Address:
City, State & Zip Code:
Occupation:
Number of Years Acquainted:
Additional Information
Do you possess a Valid CA Guard Card?

YesNo
If yes, please provide your Guard Card Number:
Do you possess a Valid Baton, OC/Chemical Agents and/or Exposed Firearms Permits?

YesNo
If yes, please provide your certification numbers:
Are you CPR Certified?

YesNo
If yes, please provide expiration date:

Please Read Carefully, Initial Each Paragraph and Sign Below
I hereby certify that I have not knowingly withheld any information that might adversely affect my chances for
employment and that the answers given by me are true and correct to the best of my knowledge. I further certify that I, the
undersigned applicant, have personally completed this application. I understand that any omission or misstatement of
material fact on this application or on any document used to secure employment shall be grounds for rejection of this
application or for the immediate discharge if I am employed, regardless of the time elapsed before discovery.
Signature

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I hereby authorize Golden Empire Security, Inc. to thoroughly investigate my references, work record,
education and other matters related to me suitability for employment (excluding criminal background information) unless
otherwise specified above. I further authorize the references I have listed to disclose to the company any and all letters,
reports and other information related to my work records, without giving me prior notice of such disclosure. In addition, I
hereby release the Company, my former employers and all other persons, corporations, partnerships, and associations
from any and all claims, demands or liabilities arising out of or in any way related to such investigation or disclosure.
Signature

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I understand that nothing contained in the application or conveyed during any interview which may be granted
or during my employment, if hired, is intended to create an employment contract between me and the Company. In addition,
I understand and agree that if I am employed, my employment is for no definite or determinable period and may be
terminated at any time, with or without prior notice, at the option of either myself or the Company, and that no promises or
representations contrary to the foregoing are binding on the Company unless made in writing and signed by me and the
Company’s designated representative.
Signature

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In compliance with federal law, all persons hired will be required to verify identity and eligibility to work in the
United States and to complete the required employment eligibility verification document form upon hire.
Signature

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The Company will consider qualified applicants, including those with criminal histories, in a manner consistent with state and local “Fair Chance” laws.
Applicant Name:
Applicant Signature:

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Date

MonthDayYear
Date
Should be Empty:

Applicant Information

Employment Position

Personal Information

Personal Information:

Job Skills/Qualifications

Education and Training

Military

Previous Employment

References

Additional Information

Please Read Carefully, Initial Each Paragraph and Sign Below

The Company will consider qualified applicants, including those with criminal histories, in a manner consistent with state and local “Fair Chance” laws.