APPLICATION FOR EMPLOYMENT(PLEASE PRINT AS NEAT AS POSSIBLE)Name* First Middle Last SS#*Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Phone*(cell or landline) (circle one)HeightWeightGenderMaleFemaleWORK HISTORY(list most recent job first) CompanyImmediate SupervisorPay Rate( per hour / per week ) (please circle)Start Date End Date Reason for LeavingMay we Contact?YesNoPhone NumberCompanyImmediate SupervisorPay Rate( per hour / per week ) (please circle)Start Date End Date Reason for LeavingMay we Contact?YesNoPhone NumberCompanyImmediate SupervisorPay Rate( per hour / per week ) (please circle)Start Date End Date Reason for LeavingMay we Contact?YesNoPhone NumberEDUCATIONName of High SchoolDid You Graduate?YesNoName of College or Trade SchoolDid You Graduate?YesNoDESIRED EMPLOYMENTWhat date can you start? What is your availability?Full TimePart TimeCan you work “graveyard” shifts (7pm-7am)?YesNoAre you available weekends?YesNoHave you ever worked security before?YesNoIf yes when/where?Are you aware that working in the field of private security is an inherently dangerous job that could lead to possible injury, serious injury, and or death?YesNoHave you ever been licensed or registered with the Texas Department of Public Safety-Private Security Bureau? (formerly the Texas Commission on Private Security)YesNoIf yes, what license(s) do you/did you hold?Do you have your own firearm and/or duty belt equipment?YesNo(if no, or the equipment does not meet our standards, equipment can be provided by the company)Are you willing to be “On-Call”?YesNoIF YOU ARE APPLYING FOR A SECURITY OFFICER POSITION (OR OTHER LICENSED POSITIONS) YOU ARE REQUIRED BY LAW TO ANSWER THE FOLLOWING QUESTIONS TRUTHFULLY. THESE ARE THE SAME QUESTIONS THAT WILL BE REQUIRED TO ANSWER IN ORDER TO HAVE YOUR LICENSED GRANTED BY THE TEXAS DEPARTMENT OF PUBLIC SAFETY-PRIVATE SECURITY BUREAU.Have you ever been convicted in any court of law of a misdemeanor crime of domestic violence?YesNoHave you ever been convicted in any court of law to a crime punishable by imprisonment for a term in excess of one year?YesNoAre you under indictment for a crime punishable by imprisonment for a term in excess of one year?YesNoAre you a fugitive from justice?(have you ever fled from the state to avoid prosecution?)YesNoAre you an unlawful user of a controlled substance or addicted to any controlled substance?YesNoHave you ever been adjudicated as a mental defective or been committed to a mental institution?YesNoHave you ever been discharged from the Armed Forces under dishonorable conditions?YesNoHave you ever renounced your citizenship?YesNo(if yes, when and where?)Have you ever been ordered by a court of law to refrain from harassing, stalking, or threatening an intimate partner or child?YesNoHave you ever been ordered by a court of law to refrain from engaging in any conduct that would place an intimate partner or child in reasonable fear of bodily injury?YesNoAre you currently prohibited, or have you been prohibited from carrying a firearm under any federal or state law?YesNoHave you ever been arrested for a Felony, Class A or B Misdemeanor, or have ever been court martialled?YesNoQUESTIONS BELOW ARE REQUIRED BY THE TEXAS ADMINISTRATIVE CODE (TITLE 37, PART 1, CHAPTER 35, SUBCHAPTER M, RULE 35.201)What is your date of birth? What is your place of birth? City State / Province / Region AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwe Country COMPLETE THIS SECTION ONLY IF YOU HAVE SECURITY EXPERIENCEHave you ever worked security at a Hotel, Motel, Resort, Apartment or Condo?YesNoIf YES, describe belowName of LocationAddressSecurity CompanyHave you ever worked security at a Commercial Building?YesNoIf YES, describe belowName of LocationAddressSecurity CompanyHave you ever worked security at a High-Tech firm?YesNoIf YES, describe belowName of LocationAddressSecurity CompanyHave you ever worked security at a Nightclub, restaurant or bar?YesNoIf YES, describe belowName of LocationAddressSecurity CompanyHave you ever worked security at an Event?YesNoIf YES, describe belowName of EventAddressSecurity CompanyHOW DID YOU HEAR ABOUT NEXT LEVEL SECURITY?GoogleYelpSocial MediaReferralExperienceNLS EmployeePERSONAL REFERENCES OR FAMILY MEMBERS (EMERGENCY CONTACTS)NAMEAddress Street Address City State / Province / Region ZIP / Postal Code PhoneNAMEAddress Street Address City State / Province / Region ZIP / Postal Code PhoneINCIDENT REPORT ASSESSMENTPLEASE FILL OUT THE FOLLOWING INCIDENT REPORT. YOU GET TO MAKE UP THE SCENARIO, CHARACTERS INVOLVED, TIME AND DATE OF THE EVENT. THE ONLY PURPOSE OF THIS REPORT IS TO GAUGE YOUR REPORT WRITING SKILLS. PLEASE FILL OUT AS NEATLY AND COMPLETELY AS POSSIBLE.LOCATIONDATE TIME : HH MM AM PM OFFICERSUBJECTDETAILSWAS THERE AN ARREST?YesNoPOLICE OFFICER RESPONDINGBADGE#POLICE DEPARTMENTYOUR SIGNATUREDATE PRE-EMPLOYMENT AGREEMENTI have read and understand this application, and further understand that any employment given to me as a result of my application will require that I undergo a comprehensive background investigation. I agree to cooperate in such investigation. My signature below serves as authorization for the company, it’s client(s) or any third party to contact any former employer, school, or personal reference set forth in this application. My signature below also authorizes the investigator to contact any other appropriate sources as part of a background investigation on me. The investigator and any person or entity contacted is hereby released and held harmless based on information obtained or provided and any decision made from such information obtained. A copy of my signature shall be deemed an original for purposes obtaining information. I understand that as a condition of my employment I may be required to complete satisfactorily a physical examination, testing for drug and/or alcohol abuse, psychological testing and credit check. I release the company from any claim arising out of any test the company may require, and waive all rights to damages of any form I may suffer from submitting to such test. I also understand that as a condition of my employment I must sign and abide by the company’s Employee Manual, Safety Training Guidelines, Non-Disclosure/Non-Compete, Personal Use of Company/Client/Property Agreement, Uniform Return Agreement and any and all addendums that are implemented after my first day of employment. I further agree that, just as I can terminate the employment relationship at any time for any reason, so too, the company may terminate my employment at any time and for any or no reason, with or without notice. I further understand that if I was attracted to employment with the company through an advertisement using an annual or salary example that I understand that i am not offered an annual salary and will be paid an hourly rate per hour of work on site at whichever location I am scheduled. Minimum or maximum number of work hours on a weekly basis will be determined by the company. I further understand that I will only be paid for hours actually worked. Moreover, I understand that no supervisor or any other employee of the company other than the Owners, has any authority to enter into any agreement or employment for any defined period of time, or to make any agreement contrary to the foregoing. I certify that the information I have given in this application is true. I realize that any commission or misrepresentation of the facts on my part will be grounds for immediate dismissal. I certify that I have read and understand the foregoing agreement and that no one has made any promise or agreement contrary to it, and agree to be bound by its terms.YOUR SIGNATUREDATE This iframe contains the logic required to handle Ajax powered Gravity Forms.