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We consider
applicants for all positions without regard to race, color,
religion, creed, gender, national origin, age, disability,
marital or veteran status, or any other legally protected
status. This application is designed to comply with federal
and state fair employment laws while collecting information
required by state laws that control the activities of
security companies. |
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DIRECTIONS:
Please complete ALL sections of this application. Print
clearly where written information is required. Where choices
are provided, check the most appropriate response(s). |
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PERSONAL
INFORMATION |
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Name: First
Middle
Last
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Application Date:
00/00/0000
Social Security Number:
000-00-0000 |
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Home Phone Number:
000-000-0000
Other Phone Number:
000-000-0000
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Email Address:
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Over the age of 18?
U.S. Citizen
Registered Alien
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RESIDENCES - List residences for the last five (5)
years starting with the most recent. |
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Address:
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City:
State:
Zip:
From:
To:
00/00/00 |
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Address:
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City:
State:
Zip:
From:
To:
00/00/00 |
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Address:
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City:
State:
Zip:
From:
To:
00/00/00 |
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POSITION APPLIED FOR:
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Security Officer
Strike Guard
Investigator
Full Time
Part Time
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Have you completed an application with USA Special Services,
LLC previously?
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Do you object to wearing a uniform?
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Are you willing to work overtime when needed?
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Are willing to work shift work?
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TRANSPORTATION |
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Public
Own Personal Vehicle
Valid Pa Driver's License
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EDUCATION - List all schools, including any special
training schools |
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NAME
ADDRESS |
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ELEMENTARY
Last Year:
0000
Graduate
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HIGH SCHOOL
Last Year:
0000
Graduate
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COLLEGE
Last Year:
0000
Graduate
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OTHER
Last Year:
0000
Graduate
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Are you known to schools/references by another name?
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If yes by what name:
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MILITARY
SERVICE:
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Branch:
Date Entered:
Date Discharged:
00/00/00
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Type of Discharge Received:
Reserve/National Guard Status:
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CHARACTER REFERENCES -
Give full names of three (3) people who have
known you for at least five (5) years.
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Do not give former employers or relatives: |
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Name:
Address:
City:
State:
Zip:
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Phone Number:
000-000-0000
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Name:
Address:
City:
State:
Zip:
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Phone Number:
000-000-0000
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Name:
Address:
City:
State:
Zip:
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Phone Number:
000-000-0000
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ADDITIONAL
QUALIFICATIONS |
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First Aid
CPR Certified
EMT Certified
Weapon Certified
Bonded
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Are you able to perform the essential functions for the
position for which you are applying?
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If no, explain:
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EMPLOYMENT HISTORY:
List all
periods of employment for the past ten (10) years, starting
with the most recent employer work backwards. Any periods of
unemployment must be noted. |
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Dates: From:
To
00/00/00
Employer:
Position Held:
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Address:
City:
State:
Zip:
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Rate of Pay:
Supervisors Name:
Reason For Leaving: |
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Dates: From:
To
00/00/00
Employer:
Position Held:
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Address:
City:
State:
Zip:
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Rate of Pay:
Supervisors Name:
Reason For Leaving: |
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Dates: From:
To
00/00/00
Employer:
Position Held:
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Address:
City:
State:
Zip:
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Rate of Pay:
Supervisors Name:
Reason For Leaving: |
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Dates: From:
To
00/00/00
Employer:
Position Held:
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Address:
City:
State:
Zip:
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Rate of Pay:
Supervisors Name:
Reason For Leaving: |
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Dates: From:
To
00/00/00
Employer:
Position Held:
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Address:
City:
State:
Zip:
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Rate of Pay:
Supervisors Name:
Reason For Leaving: |
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Are you employed at the present time?
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May we contact your present employer?
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Are you on lay-off and subject to re-call?
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Have you ever been convicted of a crime by a civilian or
military court?
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If yes, list convictions and state circumstances:
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State laws prohibit the employment of security officers with
certain types of convictions. In addition, state laws
require a comprehensive evaluation of persons entering
private security. This includes a criminal record search.
Employment may be terminated if a criminal record is found. |
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Please write a paragraph of 50 word or more explaining why
you are interested in working in security. Include your
likes and dislikes: |
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DATE OF BIRTH: (OPTIONAL)
00/00/0000
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The Age
Discrimination in Employment Act prohibits discrimination on
the basis of age with respect to individuals who are at
least 40 years of age. You must be 18 years of age to be
considered for employment. |
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HEALTH:
Many health-related problems are classified as handicaps.
State and Federal laws prohibit discrimination based on the
handicap of an otherwise qualified applicant. Upon being
offered employment, your medical history will be reviewed.
You may be asked to take a physical examination. You will be
assigned to only those jobs that you are physically able to
perform. Reasonable accommodations will be made. For your
information, many state laws prohibit the employment of
security officers who have mental or nervous disorders.
Also, certain positions, by terms of our contracts, set
standards for hearing, vision, speech, walking, lifting and
other health related areas.You may choose to discuss areas
of concern prior to completion of the employment process. |
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In
consideration of the employment and wages to be paid to me
by the Company, I make the following declarations: |
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I
authorize investigation of all matters contained in this
application and agree that if, in the judgement of the
Company, any misrepresentation has been made by me herein,
or if the results of such investigation are not
satisfactory, any offer of employment made by the Company
may be withdrawn, or my employment with the Company may be
terminated immediately without any obligation or liability
to me, other than for payment, at the rate agreed upon, for
services actually rendered if I have been employed. |
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I agree
that I will not accept employment by any client or former
client or competitor of the Company, where I have been
employed by the Company, for a period of 120 days from the
termination of my employment with the Company. I agree that
I will not divulge to anyone, other than as I may be
directed by the Company, any information acquired by me
during my employment, except as may be required by law. |
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I
understand that all appointments are probationary for 90
days, during which time I must demonstrate my ability for
continued employment. I further certify that all statements
made by me on this application are true and complete to the
best of my knowledge and belief. |
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HOW DID YOU LEARN ABOUT USA SPECIAL SERVICES, LLC?
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Walk-in
Advertisement
Employment Agency
Relative
Internet
Yellow Pages
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Employee
Name:
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