SecurityPros Inc. Application for Employment Step 1 of 11 9% Personal InformationName* First Middle Last Current Address Street Address City State / Province / Region ZIP / Postal Code Country AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands How long have you lived at this address? Email Home PhoneMobileWhen is the best time for us to call you? What employment position are you interested in? (You may select multiple positions.) Full Time Part Time Fill-in/On Call Special Events How did you hear about us? The Bulletin Craigslist Current Employee Other Please enter all previous home addresses from the past ten years.Street AddressCityState Driving HistoryDo you posses a current driver's license? Yes No License State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State In order to drive a company motor vehicle on the job, you must meet the minimum requirements set by our insurer. Within the last three (3) years, have you: Had any at-fault accidents? Had any moving traffic citations? Had any driving under the influence of intoxicants (DUII) convictions? Had your driver's license denied, suspended, or revoked? Can you with or without reasonable accommodation drive a standard transmission? Yes No Do you have reliable transportation if we need you to drive your personal vehicle occasionally on the job? Yes No Do you have automobile liability insurance? Yes No Name of Insurance Company Policy Number Past Employment History Please provide complete and accurate employment information, with the most recent employment first, for the past ten (10) years. Please include United States Military service and periods of unemployment or education.ListMonth of EmploymentYear of EmploymentMonth of DepartureYear of DepartureName of EmployerEmployer's AddressSupervisor's Phone NumberName of SupervisorAre you currently employed here? (Yes/No) Have you ever been employed by SecurityPros, Inc. or Serenity One Security, Inc. (SOS) before? Yes No When were you employed by SecurityPros, Inc. or Serenity One Security, Inc.? Where were you employed by SecurityPros, Inc. or Serenity One Security, Inc.? How far are you willing to commute to our work sites? Bend Redmond Madras Others If your application is considered favorably, on what date will you be available for employment? MM slash DD slash YYYY Education HistoryDo you have a High School Diploma or GED? Yes No Have you attended college, junior college, community college, or vocational school? Yes No How many years of college education did you complete? Please list any other special training that you have received.Please list any additional information not included in this application that you feel may be of value to us in considering you for employment. Private Security Certification Requirements If you are applying for a security officer position, as a condition of hire and/or continued employment, you must meet and maintain the minimum standards for certification and/or licensure for private security officers, as established by the Oregon Department of Public Safety Standards and Training (DPSST), ORS 181.870 et seq. Are you currently certified as a private security officer by the Oregon DPSST? Yes No Date of Expiration MM slash DD slash YYYY Have you ever previously had a private security officer license or certification in the State of Oregon or in any other state? Yes No Date of Expiration MM slash DD slash YYYY Have you had your private security officer license or certification denied, revoked, or suspended in any state? Yes No Date of denial, revocation, or suspension MM slash DD slash YYYY Please explain why your license or certification was denied, revoked, or suspended:Are you currently at least 18 years of age? Yes No Have you ever been convicted of any felony or misdemeanor crime in any state or country, excluding convictions that have been lawfully and effectively expunged or set aside by court order? Yes No Are you currently required to register as a sex offender in this state or any other state? Yes No Security Officer Working Conditions The following conditions or functions are essential in performing physical security work. With or without reasonable accommodation, can you:Stand up for an 8 hour shift (with legal breaks)? Yes No Walk on even or uneven surfaces for up to an 8 hour shift (with legal breaks)? Yes No Walk up and down stairs? Yes No Lift objects that may weigh 5-25 pounds (i.e. gates)? Yes No How far would you be comfortable walking during an 8 hour shift? None 0-1 Miles 1-2 Miles 3-4 Miles 5-6 Miles 7-8 Miles Work in all weather conditions outdoors? Yes No Work alone, at night, in poorly lit conditions? Yes No I am AVAILABLE to work a DAY shift (6 AM - 2 PM) on the following days: Monday Tuesday Wednesday Thursday Friday Saturday Sunday I am AVAILABLE to work a SWING shift (2 PM - 10 PM) on the following days: Monday Tuesday Wednesday Thursday Friday Saturday Sunday I am AVAILABLE to work a NIGHT shift (10 PM - 6 AM) on the following days: Monday Tuesday Wednesday Thursday Friday Saturday Sunday I am NOT AVAILABLE to work a DAY shift (6 AM - 2 PM) on the following days: Monday Tuesday Wednesday Thursday Friday Saturday Sunday I am NOT AVAILABLE to work a SWING shift (2 PM - 10 PM) on the following days: Monday Tuesday Wednesday Thursday Friday Saturday Sunday I am NOT AVAILABLE to work a NIGHT shift (10 PM - 6 AM) on the following days: Monday Tuesday Wednesday Thursday Friday Saturday Sunday Character References List three (3) personal references (not related by blood or marriage); please give complete and accurate street addresses, names, and phone numbers.Character ReferencesNameAddressPhoneHow long have you known this person? Notification and Agreement Please read all notifications carefully. Failure to do so will disqualify you from consideration for employment.I understand that SecurityPros, Inc. is a Drug-Free workplace. Pre-employment drug testing with a negative drug use result is required as a condition of hire and employment. Yes No I certify that all answers given by me in this application are true, accurate and complete. I understand taht the falsification, misrepresentation, or omission of any fact on this application (or any other accompanying or required documents) will be grounds for denial of employment or immediate termination of employment, regardless of when or how discovered. Yes No I authorize the investigation of all statements and information contained in this application, including (without limitation) my employment history, criminal background, and DMV records. I release from all liability anyone supplying such information and I also release the employer from all liability that might result from making an investigation. Yes No I understand that the Company requires the successful completion of a pre-employment urinalysis for drug testing purposes as a condition of hire and employment. By submitting this Application for Employment, I hereby consent to said test. In addition, if hired, I agree to comply with any and all Company policies and procedures regarding drug and/or alcohol testing, and agree to submit to any drug and/or alcohol test requested by the Company in accordance with its policy (including random testing), throughout the length of my employment. Yes No In addition, if hired, I agree to abide by all of the company rules and regulation, and understand that, if employed, my employment may be terminated with or without cause, and with or without notice, at any time, at the option of either the company or me. I further understand that no representation, whether oral or written by any representative or agent of the Company, at any time, can constitute a contract of employment (express or implied). I understand that the Company and all Plan Administrators shall have the maximum discretion permitted by law to administer, interpret, modify, discontinue, enhance, or otherwise change all policies, procedures, benefits, or other terms or conditions of employment. No representative or agent of the company has the authority to enter into any agreement for employment for any specified period of time or to make any change in any policy, procedure, benefit, or other term or condition of employment other than in a document signed by the President, or to make any agreement contrary to the foregoing. Yes No I acknowledge that I have read and understand the above statements and hereby grant permission to confirm the information supplied on this application by me. Yes No Driving Check Request and Release from LiabilityI understand that driving a Company vehicle (or my own vehicle, as required) is a requirement of the position I am being considered for and that having and maintaining a satisfactory driving record is a condition of my employment. I agree to allow SecurityPros, Inc. to check my driving record prior to hire and (if hired) to check it periodically thereafter. I further agree to report any license suspensions, serious accidents or offenses, or any other condition to my supervisor immediately that may affect my ability to drive a Company vehicle (or my own vehicle, if I am required to drive) after I am hired. I agree to obtain a Driver's license prior to hire if I do not already have one. Yes No I understand that the Company will use this information for application or employment purposes only and will not furnish this information to a third party without my written consent. Yes No I agree to release SecurityPros, Inc., its employees and those who supplied you with the information from any liability for any damage which may result from furnishing the requested information or my failure to be hired for the position for which I am applying. Yes No Consent to Procurement of Personal Background InformationI understand that, as a condition of my consideration for employment with SecurityPros, Inc. and/or as a condition of my continued employment with SecurityPros, Inc., SecurityPros, Inc. may obtain a consumer report that includes, but is not limited to, employment and education verifications, social security verification, criminal and civil history, personal interviews, DMV records, any other public records and any other information bearing on my character, general reputation, personal characteristics and trustworthiness. Yes No I hereby authorize and consent to SecurityPros, Inc.'s procurement of such a report. SecurityPros, Inc. will provide me with a copy of any such report if the information contained in such report is, in any way, to be used in making a decision regarding my fitness for employment with SecurityPros, Inc. I further understand that such report will be made available to me prior to any such decision being made, along with the name and address of the reporting agency that produced the report. Yes No Authorization to Release Employment InformationI hereby authorize any previous employer I listed on this application to provide SecurityPros, Inc. with any information you/it may have concerning my prior employment, which is on record or otherwise (including, without limitation, my personnel records) and do hereby release SecurityPros, Inc., the previous employer, and all individuals connected therewith, from any and all liability whatsoever that might otherwise be incurred in furnishing such information and documentation. Yes No Please verify: Δ
