EQUAL OPPORTUNITY EMPLOYER

APPLICATION FOR EMPLOYMENT & PRE-EMPLOYMENT QUESTIONNAIRE

DATE

NAME
/ E-MAIL ADDRESS
PRESENT ADDRESS
/ CITY
/ STATE
/ ZIP CODE
PERMANENT ADDRESS
/ CITY
/ STATE
/ ZIP CODE
PHONE NUMBER
/ REFERRED BY

EMPLOYMENT DESIRED Full Time: Part Time:

POSITION
/ DATE YOU CAN START
/ SALARY DESIRED
ARE YOU CURRENTLY EMPLOYED?
YES NO / IF SO, MAY WE INQUIRE OF YOUR PRESENT EMPLOYER?
YES NO
HAVE YOU EVER APPLIED TO SLOAN SECURITY GROUP BEFORE?
YES NO / WHEN?
/ WERE YOU HIRED?
YES NO

EDUCATION HISTORY

NAME LOCATION OF SCHOOL / YEARS ATTENDED / DID YOU GRADUATE? / SUBJECTS STUDIED
HIGH SCHOOL
COLLEGE
TRADE, BUSINESS OR
CORRESPONDENCE SCHOOL
SUBJECTS OF SPECIAL STUDY, RESEARCH, WORK, OR SPECIAL TRAINING OR SKILLS
BRANCH OF UNIFORMED SERVICE
/ RANK, LENGTH OF SERVICE, AND TYPE OF DISCHARGE

GENERAL INFORMATION

CRIMINAL HISTORY LIST ANY MISDEMEANOR OR FELONY CONVICTIONS, INCLUDING OFFENSE(S), LOCATION AND DATE

FORMER EMPLOYERS LIST YOUR LAST FOUR EMPLOYERS, BEGINNING WITH THE MOST RECENT

MONTH & YEAR / NAME ADDRESS OF
EMPLOYER AND SUPERVISOR / SALARY / POSITION / REASON FOR LEAVING
FROM
TO
FROM
TO
FROM
TO
FROM
TO

REFERENCES PROVIDE THE NAMES OF THREE PERSONS NOT RELATED TO YOU, WHOM YOU HAVE KNOWN AT LEAST ONE YEAR

NAME / ADDRESS & TELEPHONE # / BUSINESS / OCCUPATION / YEARS KNOWN

Prior to offer of employment, are you willing to participate in a drug test, medical exam, and background check? Yes  No (Results will determine the continuance of hire. You must meet standards of company policy. A negative response to this inquiry may consider this application rejected.) Applicant’s Initials Do you have a valid driver’s license? Yes No

Are you 18 years or older? Yes No

This organization participates in E-Verify

AUTHORIZATION

“I certify that the facts contained in this application are true and complete to the best of my knowledge and understand that, if employed, falsified statements on this application shall be grounds for termination.

I authorize investigation of all statements contained herein and I authorize the references and employers listed above to provide Sloan

Security Group any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise, and release them from all liability for any damage that may result from utilization of such information.

I also understand and agree that no representative of Sloan Security Group has any authority to enter into any agreement for employment for any specified period, or to make any agreement contrary to the foregoing, unless it is in writing and signed by an authorized representative.

This waiver does not permit the release or use of disability-related or medical information in a manner prohibited by the Americans with

Disabilities Act (ADA) and other relevant federal and state laws.”

Signature:


Date: