Job Application Form

Full Name*

First NameLast Name

E-mail*

Phone Number*

Area CodePhone Number

What position are you applying for?

Available start date:*

MonthDayYear

What is your current employment status?

EmployedUnemployedSelf-EmployedStudent

Submit your resume?

Upload File

Upload a File

Submit your photo?

Upload a File

AUTHORIZATION FOR RELEASE OF PERSONAL INFORMATION*

Type your name

I do hereby authorize a review of and full disclosure of all records concerning myself to any duly authorized agent of Global Security Services-IA whether said records are public, private or confidential in nature.

The intent of this authorization is to give my consent for a full and complete disclosure of records of educational institutions, including records of loans, the record of commercial of retail credit agencies (including credit reports and/or rating) and other financial statements of record whenever filed; medical and psychiatric treatment and/or consultation, including hospitals, clinics, private practitioners, and U.S. Veteran’s administration; employment and pre-employment records; including background reports, efficiency ratings, complaints, or grievances filled by me or another persons in any case, either criminal or civil, in which I presently have, or have had an interest.

I understand that any information obtained by a personal history background investigation which is developed directly or indirectly, in whole or part, upon this release releases said persons(s) from any and all liability which may be incurred as a result of furnishing such information. I further release Global Security Services from any and all liability which may be incurred as a result of collecting such information.

I HEREBY SWEAR AND AFFIRM THAT EACH STATEMENT AND ALL INFORMAITON IN OR SUPPORTING THIS APPLICATION ARE COMPLETE, TRUE AND ACCURATELY RECORDED TO THE BEST OF MY KNOWLEDGE. I UNDERSTAND THAT PROVIDING FALSE, OR MISLEADING AND/OR INCOMPLETE INFORMATION ON THIS APPLICATON IS GROUNDS FOR EXCLUSION FROM THE SELECTION PROCESS OR DISCHARGE IF DICOVERED SUBSEQUENT TO EMPLOYMENT.

A photocopy or fax of this release form will be valid as an original thereof, even though the said photocopy or fax does not contain an original of my signature.

I have read and fully understand the contents of this “Authorization for Release of Personal Information”.

AUTHORIZATION TO PROCURE INVESTIGATIVE CONSUMER REPORT*

Type your name

I do hereby authorize Global Security Services-IA, Ltd. or it’s agent, to prepare an investigative consumer report including criminal, civil, motor vehicle, and other records. I authorize full disclosure of all records concerning myself to any duly authorized agent of Global Security Services, Ltd. and Global Security Services-IA, Ltd. whether said records are public, private or confidential in nature.

The intent of this authorization is to give my consent for full and complete disclosure of my records regarding my credit worthiness, credit standing, credit capacity, character, general reputation, personal characteristics, mode of living, work habits, work performance and experience, including, where applicable, the reasons for disciplinary action in or termination of current or past employment. I understand that this information may be derived from interviews with neighbors, friends, associates or other acquaintances, including professional and personal references and previous employers. This report will be used for employment purposes as defined in the Fair Credit Report Act, Section 603 (h). In using a consumer credit report for employment purposes, before taking adverse action, based in whole or in part on the credit report, the person taking such action shall provide the consumer to whom the report relates a copy of the report and a description in writing of the rights of the consumers rights (copy provided) under the Fair Credit Reporting Act, as prescribed by the Federal Trade Commission, Section 609 (c) (3).

I understand that any information obtained by a personal history background investigation which is developed directly or indirectly, in whole or part, upon this form releases said persons(s) from any and all liability which may be incurred as a result of furnishing such information. I further release Global Security Services-IA, Ltd. from any and all liability which may be incurred as a result of collecting such information.

Full Name (First, Middle, Last)*

Alias or other names used, including maiden

Date of Birth:*

XX/XX/XXXX

Social Security Number:*

XXX-XX-XXXX

Driver License Number:*

State of Driver License Issance:

Current Address:

Current City:

Current State:

Current Zip Code

Are you a U.S. Citizen

YesNo

Please indicate the highest overall grade you completed (9-16)

Did you graduate high school or obtain a general equivalence diploma (GED)

YesNo

If you are working toward a degree, what is your anticipated graduation date:

Has any disciplinary action, including scholastic probation and/or dismissal, ever been taken against you during your academic career?

YesNo

List awards, honors, citations, athletic endeavors and any other special recognition you have received:

. List any special abilities (i.e. computer skills, weapons, typing, etc.), special interest or hobbies:

List languages, including American Sign Language (ASL), that you speak, read and write fluently:

Are you licensed or certified to practice a trade or professional:

YesNo

Description of Duties or Worked Performed:

List chronologically ALL of your residences for the past 10 years. Please include addresses while attending school if away from home and all military addresses including off base locations.

What is the total amount of your monthly financial obligations?

$0.00

Are monthly financial obligations kept current?

YesNo

Do you have any sources of income other that your salary?

YesNo

Have you ever been arrested or charged with a crime?

YesNo

Have you ever been issued a traffic citation?

YesNo

If you answered YES to either of the questions above, whether or not formally charged, whether a court appearance was required, the matter was settled by payment, or the situation was otherwise disposed of; please list all such matters below.

Date, City/State, Charges and details

Have you registered with Selective Services, if applicable?

YesNo

Have you ever applied for a position with any branch of the U.S. Armed Forces?

YesNo

Have you ever been rejected by any branch of the Armed Forces for any reason?

YesNo

If yes to the above question state the reason:

Have you ever served on active duty in any branch of the Armed Forces?

YesNo

If YES, please list the branch of services, rank attained and MOS/Duties

Type of Discharge

HonorableDishonorableN/A

Member of Reserve or National Guard

YesNoN/A

Was any disciplinary action taken against you in the service?

YesNo

Are you now, or have you ever been, a member of any club, society, organization?

YesNo

Address:

Have you ever been a member of any police/sheriff, fire fighting or other civic group?

YesNo

If you answered YES to either of the above, please list such activities below.

List your work experience, starting with the most recent experience accounting for all time. Please be specific. Omissions may result in disqualification for employment.

Name of Employer:

Position Held:

Address:

City/State/Zip:

Phone:

Name of Supervisor:

Salary (Start)

Salary (End)

Start Date:

End Date:

Name of Employer:

Position Held:

Address:

City/State/Zip:

Phone:

Name of Supervisor:

Salary (Start)

Salary (End)

Start Date:

End Date:

Name of Employer:

Position Held:

Address:

City/State/Zip:

Phone:

Name of Supervisor:

Salary (Start)

Salary (End)

Start Date:

End Date:

Name of Employer:

Position Held:

Address:

City/State/Zip:

Phone:

Name of Supervisor:

Salary (Start)

Salary (End)

Start Date:

End Date:

Give three references who are responsible adults of reputable standing in their communities who have known you well for at least five years (preferably the last five years.). Do not use relatives, former or present employers, co-workers or school teachers. If retired, list their former occupation.

Name:

Occupation:

Address:

City/State/Zip:

Phone:

Number of years acquainted:

Name:

Occupation:

Address:

City/State/Zip:

Phone:

Number of years acquainted:

Name:

Occupation:

Address:

City/State/Zip:

Phone:

Number of years acquainted:

Enter the message as it's shown*

I HEREBY SWEAR AND AFFIRM THAT EACH STATEMENT AND ALL INFORMAITON IN OR SUPPORTING THIS APPLICATION ARE COMPLETE, TRUE AND ACCURATELY RECORDED TO THE BEST OF MY KNOWLEDGE. I UNDERSTAND THAT PROVIDING FALSE, OR MISLEADING AND/OR INCOMPLETE INFORMATION ON THIS APPLICATON IS GROUNDS FOR EXCLUSION FROM THE SELECTION PROCESS OR DISCHARGE IF DICOVERED SUBSEQUENT TO EMPLOYMENT.

Signature

Global Security Services-Employment Application

UNIFORM MEASUREMENTS

INTERNSHIP/WORK STUDY PROGRAM

RESIDENCE HISTORY

FINANCIAL INFORMATION

ARREST AND CONVICTION RECORD

SELECTIVE SERVICE / MILITARY RECORD

ORGANIZATION MEMBERSHIP / VOLUNTEER ACTIVITIES

EMPLOYMENT HISTORY

REFERENCES