Employment Application Form

Employment Application
Name: *

First Name Last Name
Birth Date *

Month Day Year
Phone Number: *

Area Code Phone Number
E-mail Address: *
Address: *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Date Available to Start

Month Day Year
Date
Have you ever been convicted of a violation of the law other than a minor traffic violation? (Answering yes will not automatically bar you from obtaining a position) *

Yes No
If yes, please explain
Have you ever applied to work with us before? *

Yes No
If yes, when?
If hired, proof of your identitiy and employment eligibility in the United States must be established by appropriate documentation at the time you begin work at Premier Security Solutions
Are you willing to work an irregular schedule, overtime, different shifts, and weekends when necessary? *

Yes No
If no, please explain

Education
Highschool and Year Completed
College and Year Completed
Other (Specify)
U.S. Military Service
Branch
Highest Rank Achieved
Duties
Dates of Service
Example: December 1994-August 1998
Job Skills & Training
Describe your skills:
Training or Certifications:
Upload Resume:

Employment
1. Most Recent Employer's Name
Name of Company
Last Date Worked

Month Day Year
Date
How Long Were You Employed There?
Example: 3 years
Reason for Leaving
Your Duties
Describe your Departure
2. Employer's Name
Name of Company
Last Date Worked

Month Day Year
Date
How Long Were You Employed There?
Example: 3 years
Reason for Leaving
Your Duties
Describe your Departure
3. Employer's Name
Name of Company
Last Date Worked

Month Day Year
Date
How Long Were You Employed There?
Example: 3 years
Reason for Leaving
Your Duties
Describe your Departure
4. Employer's Name
Name of Company
Last Date Worked

Month Day Year
Date
How Long Were You Employed There?
Example: 3 years
Reason for Leaving
Your Duties
Describe your Departure

References

Please list two (2) references that are familiar with your work life.
Reference 1
Name: *

First Name Last Name
Phone Number *

Area Code Phone Number
Years Known: *
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Reference 2
Name: *

First Name Last Name
Phone Number *

Area Code Phone Number
Years Known: *
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
In Case of Emergency Notify:
Name *

First Name Last Name
Phone Number *

Area Code Phone Number
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Relationship *
Example: Mother
How were you referred to us? *

Walk-In Employee Newspaper Ad Facebook Indeed Craigslist
If referred by employee, please list their name.

Certification and Authorization - Please Read Thoughtfully
I certify that all facts contained in the application are true and complete and acknowledge that the company is relying on the accuracy of the information provided. I authorize the company to verify the accuracy of the information provided herein, and I authorize former employers, educational institutions and credit agencies to release information concerning me to the company. I also authorize the company to give references and provide information about me in response to inquires subsequent to my employment if hired. I understand that falsification, misrepresentation or omission of requested facts may result in denail of employment or, if employed, may result in immediate dismissal. I understand and agree that, if hired, my employment will be for no definite period and may, regardless of the date of payment of wages, be terminated at any time without previous notice and with or without reason, at the will of either myself or the company. I also understand and agree that no one has authority to promise me job security or continued employment, except the CEO of the Company in a formal written agreement signed by both of us.
Name *

First Name Last Name
Signature of Applicant *

Clear
Date *

Month Day Year
Date
Should be Empty: