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PERSONAL INFORMATION:
*Last Name:
* First Name   * MI:  
SSN:
*DOB / / (mm/dd/yyyy)
*Present Address:



*City: * State  *Zip
Phone Number: *Daytime: *Evening:
*Email Address:
*Position applying for:
Desired Hourly Rate: ($0.00)
If requested, would you be willing to take a drug/alcohol screening exam as a condition of employment?
Yes No
   

AVAILABILITY FOR WORK:
*When can you can start
Type of work:
Shift Desired:
Will you work overtime if necessary?    Yes   No
Will you work weekends if necessary?  Yes   No
Do you have any ongoing or other personal commitments that would affect your work schedule? If yes, please explain.
Have you ever been convicted of any law violation, except a minor traffic violation? (a criminal record does not automatically bar employment). If yes, please explain.

MILITARY RECORD:
Branch of service:   
Type of discharge:
 

EDUCATION:
*Level of Education
Special Training or Skills:
       

FORMER EMPLOYERS

    
Name of present employer or last employer  
   
Address        
 
 
 
 
Phone number    
Job Title    
Starting Date (mm/dd/yy) Leaving Date (mm/dd/yy)
/ / / /
Starting salary   Final salary
     
Reason for leaving:    

Explanation:

 
Description of Duties:      
 
 
 
 
         
 
Name of Present or Last Employer  
   
Address        
 
 
 
 
Phone number    
Job Title    
/ / / /
Starting salary   Final salary
     
Reason for leaving:    
Explanation:
  
Description of Duties:    
 
 
 
 
         
 
Name of Present or Last Employer  
   
Address        
 
 
 
 
Phone number    
Job Title    
Starting Date (mm/dd/yy) Leaving Date (mm/dd/yy)
/ / / /
Starting salary   Final salary
     
Reason for leaving:    
 
Description of Duties:    
 
 
 
 
         
         

BUSINESS REFERENCES

    
Name    
Company    
Relationship to you   Phone number
 
 
Name    
Company    
Relationship to you   Phone number
 
 
Name    
Company    
Relationship to you   Phone number
 
         
     
 

 
 
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Preeminent Protective Services, Inc.
VA License Number 11-3851
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