APPLICATION FOR EMPLOYMENT
(Please Print)
Name:
Last First Middle
Address:
City State Zip
Email Address:
Telephone (Check which preferred)
Home
Business
Mobile
Position Desired:
Full Time Seasonal Temporary Part Time Contingent
Date Available to Start: Desired Salary:
Referral Source: Employment Agency Newspaper Ad
Walk-in App. School/College
Employee Referral Other:
Have you ever been employed by Secure Management? Yes No
If “yes”, when?
Are you currently employed? Yes No Are you currently in school? Yes No
GENERAL INFORMATION
(In response to these inquiries, continue on a separate sheet if you require additional space.)
If you are under 18 years of age, can you provide a work permit? Yes No If no, please explain:
Are you legally allowed to work in the United States? Yes No
Are there any reasons you may have difficulty in performing any of the major duties of the job for which you have applied? Yes No If so, please explain:
Have you ever pleaded guilty, no contest or been convicted of a crime? Yes No
(Answering yes to these questions does not automatically disqualify you from being considered as a candidate for employment. Date of the offense, seriousness and nature of the violation, rehabilitation and Position applied for will be considered.) If “Yes”, please explain:
Are you willing to work overtime as required: Yes No
Have you ever served in the U.S. Armed Forces? Yes No
Describe any job-related skills or qualifications that would support your application:
In the following spaces give a complete record of your employment including periods of unemployment, if any. Starting with your present or most recent job and work back. If additional space is needed, attach a supplementary sheet.
Name of Employer
Brief Description of duties
Supervisor’s Name
Address
Phone #
Wage / Salary
Type of Business
Date of Employed
Title / Position
Full Time Part Time
Temporary Internship
Contingent Volunteer
Reason for leaving
SCHOOL
PRINT NAME, NUMBER, STREET
CITY, STATE, AND ZIP CODE
For each school listing
MAJOR COURSE OF STUDY & DEGREE
NO. OF YEARS COMPLETED
HIGH SCHOOL
COLLEGE
GRAD SCHOOL
TRADE, BUS., NIGHT COURSE
OTHER
(In responding to these inquiries, continue on a separate sheet if you require additional space)
May we contact your present employer? Yes No
Please identify any exceptions and reasons for not contacting:
In order to permit a check of your work and education records, should we be made aware of any change of name or assumed name that you previously used? Yes No
If “Yes”, identify name(s) and relevant dates:
Is case of Emergency or Accident, whom shall we notify?
NAME:
HOME ADDRESS:
BUSINESS ADDRESS:
HOME TELEPHONE: WORK PHONE:
MOBILE PHONE: OTHER NO.
Applicant’s Statement – Please read carefully and complete bottom portion, then sign.
The facts set forth in my application and in this release form are true and complete to the best of my knowledge, and I understand that any misrepresentation, falsification or willful omission shall be sufficient reason for dismissal from employment.
I hereby authorize investigation of all statements contained in my application and for employment with your firm regarding my personal history, financial and credit record, employment, education, criminal history, if any, or driving history through any investigative agency of your choice.
I hereby release from liability your company and all agents of your company for their acts performed in good faith and without malice in connection with evaluating my application and my credentials and qualifications. I hereby release from liability any and all individuals and organizations, any firm, institution or court, releasing data pertinent to the review of my application and information released in good faith and without malice concerning my professional competence, ethics, character and other qualifications.
I further understand that my employment will be of no definite period of time and may be terminated, with or without cause or notice, by the company or by myself.
Full Printed Name of Applicant Present Address How Long?
Previous/Maiden Name (if applicable) City State
Former Address How Long?
Driver’s License #/ Issuing State City State
Social Security Number Former Address How Long?
Date of Birth (for identification purposes only) City State
CONSUMER REPORT DISCLOSURE NOTICE
This is to inform you that as a part of our procedure for processing your employment application, or for otherwise determining your eligibility for a position with Secure Management, a consumer report or investigative consumer report may be obtained for employment purposes. This inquiry may include information as to your character, general reputation, personal characteristics, mode of living, employment history, criminal history, military records, credit history and department of motor vehicle records, whichever may be applicable.
You have the right to make a written request for a complete and accurate description of the nature and scope of the consumer report or the investigative consumer report. Address such requests to the following.
Secure Management
16100 Moross
Detroit, MI 48205
By signing below I acknowledge that I have read, understood and agree to the above statements.
Applicant Signature Date