Application - Achates Security Agency

Employment Application

"*" indicates required fields

Date

Name*

First Middle Last

Address*

Street Address Address Line 2 City State ZIP Code

Phone*

Social Security Number*

How long at current address?*

If under 18, please list age*

Position applied for*

Salary desired*

Employment desired*

FULL-TIME ONLY

PART-TIME ONLY

FULL -OR- PART TIME

How many hours can you work weekly?*

When would you be available for work?*

Days available to work*

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Sunday

Available to work nights

Available to work days

High School Graduate*

Yes

Name of School

Years Completed

Major or Degree

Address

College Graduate*

Yes

Name of School

Years Completed

Major or Degree

Address

Bus. or Trade School*

Yes

Name of School

Years Completed

Major or Degree

Address

Professional School*

Yes

Name of School

Years Completed

Major or Degree

Address

Have you ever been convicted of a crime?*

Yes

If yes, explain number of conviction(s), nature of offense(s) leading to conviction(s), how recently such offense(s) was/were committed, sentence(s) imposed, and type(s) of rehabilitation

What is your means of transportaion to work?

Do you have a valid drivers license?*

Yes

Drivers license number

State of issue

Expiration Date

Type of License

Operator

Commercial (CDL)

Chauffeur

Have you had any accidents during the past three years?*

Yes

If yes how many?

Have you had any moving violations during the past three years?*

Yes

If yes how many?

References

Please list two references other than relatives or previous employers.

Name

Position

Company

Phone

Address

Name

Position

Company

Phone

Address

MILITARY

HAVE YOU EVER BEEN IN THE ARMED FORCES?*

Yes

ARE YOU NOW A MEMBER OF THE NATIONAL GUARD?*

Yes

Speciality

Date Entered

Discharge Date

WORK EXPERIENCE 1

Please list your work experience for the past five years beginning with your most recent job held. If you were self-employed, give firm name. Attach additional sheets if necessary.

Name of Employer

Phone

Address

Street Address City State ZIP Code

Name of last supervisor

Your Job title

Employment Dates ( From - To )

Pay or Salary ( Start - Final )

Reason for leaving (be specific)

List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at this company.

WORK EXPERIENCE 2

Name of Employer

Phone

Address

Street Address City State ZIP Code

Name of last supervisor

Your Job title

Employment Dates ( From - To )

Pay or Salary ( Start - Final )

Reason for leaving (be specific)

List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at this company.

WORK EXPERIENCE 3

Name of Employer

Phone

Address

Street Address City State ZIP Code

Name of last supervisor

Your Job title

Employment Dates ( From - To )

Pay or Salary ( Start - Final )

Reason for leaving (be specific)

List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at this company.

PLEASE READ CAREFULLY

APPLICATION FORM WAIVER

In exchange for the consideration of my job application by Achates Security Agency (hereinafter called “the Company”), I agree that:

Neither the acceptance of this application nor the subsequent entry into any type of employment relationship, either in the position applied for or any other position, and regardless of the contents of employee handbooks, personnel manuals, benefit plans, policy statements, and the like as they may exist from time to time, or other Company practices, shall serve to create an actual or implied contract of employment, or to confer any right to remain an employee of Achates Security Agency, or otherwise to change in any respect the employment-at-will relationship between it and the undersigned, and that relationship cannot be altered except by a written instrument signed by the President /General Manager of the Company. Both the undersigned and Achates Security Agency may end the employment relationship at any time, without specified notice or reason. If employed, I understand that the Company may unilaterally change or revise their benefits, policies and procedures and such changes may include reduction in benefits.

I authorize investigation of all statements contained in this application. I understand that the misrepresentation or omission of facts called for is cause for dismissal at any time without any previous notice. I hereby give the Company permission to contact schools, previous employers (unless otherwise indicated), references, and others, and hereby release the Company from any liability as a result of such contract.

I also understand that (1) the Company has a drug and alcohol policy that provides for pre-employment testing as well as testing after employment; (2) consent to and compliance with such policy is a condition of my employment; and (3) continued employment is based on the successful passing of testing under such policy. I further understand that continued employment may be based on the successful passing of job-related physical examinations.

I understand that, in connection with the routine processing of your employment application, the Company may request from a consumer reporting agency an investigative consumer report including information as to my credit records, character, general reputation, personal characteristics, and mode of living. Upon written request from me, the Company, will provide me with additional information concerning the nature and scope of any such report requested by it, as required by the Fair Credit Reporting Act.

I further understand that my employment with the Company shall be probationary for a period of sixty (90) days, and further that at any time during the probationary period or thereafter, my employment relation with the Company is terminable at will for any reason by either party.

Signature*

*Click and hold down left mouse button, then move mouse to sign.

Achates Security Agency is an equal employment opportunity employer. We adhere to a policy of making employment decisions without regard to race, color, religion, sex, sexual orientation, national origin, citizenship, age or disability. We assure you that your opportunity for employment with this Company depends solely on your qualifications.

Thank you for completing this application form and for your interest in our business.