Application for employment

PRINT IN INK OR TYPE. These instructions must be followed exactly. Fill out application form completely. Do not leave any section blank. Be sure to sign when completed. Strategic Forecasting, Inc. (STRATFOR) is an equal opportunity employer. All qualified applicants will receive consideration for employment regardless of their, race, color, religion, national origin, sex, age, disability, marital status, sexual orientation or any other legally protected status entitled to protection under federal, state, or local anti-discrimination laws.

Personal Information
Name (Last, First, MI)
Previous Name (List any other names used if different from name on this application)
Date of Birth / Social Security Number / Driver’s License No./State/Expiration
Desired Position
Position you wish to apply for: / Are you legally authorized to live and work in the U.S.?
How did you hear about this position? / How did you learn about STRATFOR?
Contact Information
Email Address / Alternate Email Address
Phone Number / Alternate Phone Number / Website Address (If Applicable)
Address
Current Address
City / State or Province / Zip Code / Country
Please list the name & date of birth of all adults living at this address
Previous Address (or Permanent Address if different from above)
City / State or Province / Zip Code / Country
Please list the name & date of birth of all adults living at this address
Address – Continued
List of all cities or towns you have resided in, including time spent abroad, with dates.
Personal History
NOTE: Answering yes to these questions may not necessarilydisqualify you from employment at STRATFOR but a false statement will.
Have you ever been arrested or convicted of a crime?
If yes, please explain provide dates: / Yes / No
Have you ever been dishonorably discharged from military service?
If yes, please explain provide dates: / Yes / No
Have you ever been fired from a job or been forced to resign from a job?
If yes, please explain: / Yes / No
Have you ever resigned from a job after being told you would be fired, left after charges, allegations, or misconduct, left after charges or allegations of unsatisfactory performance, or left a job under any other unfavorable circumstances?
If yes, please explain: / Yes / No
Have you ever been suspended or received a formal warning notification for misconduct on the job?
If yes, please explain: / Yes / No
Have you ever violated security policies on the job?
If yes, please explain: / Yes / No
Have you ever been associated with a foreign intelligence organization?
If yes, please explain: / Yes / No
Have you ever been associated with an organization that is attempting to overthrow a legitimate government or have you provided material, financial or moral support for any group included on the U.S. State Department Designated Foreign Terrorist Organizations list
If yes, please explain: / Yes / No
Education
Include ALL educational institutions attended. If you need additional space, attach a sheet of paper and provide the same information in the same format as this application form. If there are any gaps in your education progression, please explain in the last section.
Educational Institution / Location
Degree or Certifications Earned, Concentration / Dates Attended
Activities and Organizations
Educational Institution / Location
Degree or Certifications Earned, Concentration / Dates Attended
Activities and Organizations
Educational Institution / Location
Degree or Certifications Earned, Concentration / Dates Attended
Activities and Organizations

If there are any gaps in your education progression, please explain:

Employment History
Starting with the most recent, describe all paid, military and applicable voluntary experience. INCLUDE ALL employment. If you need additional space attach a sheet of paper and provide the same information in the same format as this application form. If there are any gaps in your employment history, please explain in the last section.
Employer (Company Name & Address)
Dates Employed / Immediate Supervisor Name & Title / Supervisor Telephone Number
Position/Title / Specific Reason for Leaving
Employment History - Continued
Employer (Company Name & Address)
Dates Employed / Immediate Supervisor Name & Title / Supervisor Telephone Number
Position/Title / Specific Reason for Leaving
Employer (Company Name & Address)
Dates Employed / Immediate Supervisor Name & Title / Supervisor Telephone Number
Position/Title / Specific Reason for Leaving
Employer (Company Name & Address)
Dates Employed / Immediate Supervisor Name & Title / Supervisor Telephone Number
Position/Title / Specific Reason for Leaving
Employer (Company Name & Address)
Dates Employed / Immediate Supervisor Name & Title / Supervisor Telephone Number
Position/Title / Specific Reason for Leaving
Employer (Company Name & Address)
Dates Employed / Immediate Supervisor Name & Title / Supervisor Telephone Number
Position/Title / Specific Reason for Leaving

If there are any gaps in your employment history, please explain:

References
1. Professional Reference
Name / Occupation
Company Name / Phone Number
Email Address / Relationship and years acquainted.

2. Professionalor Educational Reference

Name / Occupation
Company Name / Phone Number
Email Address / Relationship and years acquainted.

3. Professional or Educational Reference

Name / Occupation
Company Name / Phone Number
Email Address / Relationship and years acquainted.

4. Peer Reference

Name / Occupation
Company Name / Phone Number
Email Address / Relationship and years acquainted.
Additional Information
In the space below you may expand on any points or questions asked previously in this application

Authorization for Background Investigation

I, authorize Strategic Forecasting, Inc. (STRATFOR) and its representative agents to conduct a background investigation to verify the information I have supplied on this application for employment. STRATFOR is entitled to seek information from my current and previous employers, educational institutions, residential agents, criminal justice agencies, credit bureaus, consumer reporting agencies and any other sources of information STRATFOR deems necessary to complete the investigation. This background check may also include interviews with associates, acquaintances and all other individuals STRATFOR believes may have knowledge of my activities, whereabouts and character. I verify that all information I have provided on this application for employment is truthful and complete to the best of my knowledge. I further understand that any false statements made on this application are grounds for denial of employment or termination of employment. STRATFOR does not make employment decisions on the basis race, color, religion, national origin, sex, age, disability, marital status, sexual orientation.

Signature

Printed Name

Date