Application For Employment pre-employment questionaire equal opportunity employer

Personal Information Date

 

Last Name First Name Middle
Social Secuirty No.
Present Address
City
State
Zip Code
Permanent Address
City
State
Zip Code
Phone #

Refered by

Employment Desired

Position
Date You Can Start
Salary Desired
Are you employed? Yes No

If so , may we inquire of your present employer? Yes No

 
Ever applied to this company before? Yes No
Where?
When?

 

Education History

Name & Location of School
Years Attended
Did You Graduate?
Subjects Studied
Grammar School
High School
College
Trade, Business or Correspondence School

General Information

Subjects of special study/research work or special training/skills

 
U.S. Military or Navy Service Rank/Grade

Former Employers (list below last four employers, starting with last one first)

Date Month and Year From and To
Name & Address of Employer Phone #
Salary
Position
Reason for Leaving

References Give below the names of three persons not related to you, whom you have know at least one year

Name Address Business Years Known

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, falsifiied statements on this application shall be grounds ofor dismissal.

I authorize investigation of all statements contained herein and the references and employers listed above to give you any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise, and release the company from all liability for any damage that may result from utilization of such information.

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

This waiver does not permit the relese 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."

Date Signature

Date Interviewed by

Security South / May & Co, Inc.

1. Have you ever been convicted of a misdemeanor? Yes No If yes when? Date or Dates?

2. Have you ever been convicted of a felony? Yes No If yes when? Date or Dates?

3. Have you ever had a DUI? Yes No If yes when? Date or Dates?

4. How long have you been a resident of Mississippi? Date or amount of time to nearst year and month.

5. How long have you lived in the Jackson Area? Date or amount of time to nearst year and month.

6. Do you have any objections to working nights/weekends? Yes No

7. How well do you get along with people? Your opinion.

8. Are you willing and able to follow the instructions of your supervisor? Yes No

9. List any qualities that you feel would make you a good guard/employee.

10. Are you willing to submit to a drug test at the present time? Yes No Would you take a test at a future date? Date.

I authorize SECURITY SOUTH/MAY & CO. to investigate any and all statements in this application. I understand that any false statements will be grounds for immediate termination. I futher understand that my employment is for no definite period during the 90 days and may be terminated at any time during this period without previous notice or reason.

Signature Date

Please do not submit at this time. This is a new feature that will be up at a later date. You may print and then fax this to our office at 601-355-4804.