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Employment Application
Employment Application Form
developer
2017-05-02T13:48:11-05:00
PERSONAL INFORMATION
Have you successfully completed high school or have an accredited GED with certificate of completion?
*
Yes
No
Illinois Resident's Only: Do you have a valid Permanent Employee Registration Card (PERC)?
*
Yes
No
Have you successfully completed state approved training courses for the state you are applying for?
*
Yes
No
Are you over the age of 21?
*
Yes
No
If under 21, please list age:
*
Name
*
First
Middle Initial
Last
Address
*
Street Address
Apartment/Unit #
City
State
Zip Code
Primary Contact Number
*
Other Phone
Best way to reach you?
Primary Contact
Other
Email
Date of Birth
MM slash DD slash YYYY
IDENTIFICATION
Social Security Number:
*
Drivers Lic/State ID Number:
*
Drivers Lic/State ID Expiration Date:
*
Permanent Employee Registration Card (PERC) Number:
*
Permanent Employee Registration Card (PERC) Expires On:
*
FIREARM OWNER'S IDENTIFICATION CARD (FOID) Number:
FIREARM OWNER'S IDENTIFICATION CARD (FOID) Expires On:
ADDITIONAL INFORMATION
Have you ever been employed by Universal Security in the past?
*
Yes
No
Year of Employment
*
I certify that I am a U.S. citizen, permanent resident, or a foreign national with authorization to work in the United States.
*
Yes
No
Have you ever been convicted of, or entered a plea of guilty, no contest, or had a withheld judgment to a felony?
*
Yes
No
If Yes, please explain:
*
EDUCATION, TRAINING, AND MILITARY SERVICE
High School
*
Name
Location (mailing address)
Year Completed
Diploma/GED
College or Business/Trade School
Name
Location (mailing address)
Year Completed
Diploma/GED
20 HOUR UNARMED SECURITY TRAINING COURSE
*
School Name where you attended course
School Address
Date you completed course:
*
MM slash DD slash YYYY
Please tell us about any other security training you’ve received:
Have you ever served in the Armed Forces?
*
Yes
No
Are you currently sworn into the Illinois Peace Corp?
*
Yes
No
Are you an ACTIVE Police Officer?
*
Yes
No
EMPLOYMENT AVAILABLITY
Select all available days and shifts.
1st Shift
*
Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Not Available
2nd Shift
*
Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Not Available
3rd Shift
*
Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Not Available
How many hours can you work weekly?
*
Date available to begin:
*
MM slash DD slash YYYY
Do you have reliable transportation to get to work?
*
Yes
No
Type of Transportation?
In case of an emergency, who should we contact?
*
First
Last
Phone Number
*
Are you currently employed?
*
Yes
No
If you are hired by Universal Security, do you need to give your current employer two-weeks notice?
*
Yes
No
WORK EXPERIENCE (1)
Work Experience- You must provide at least 5 years of work or school history
Company:
*
Job Title:
*
Name of last supervisor:
Address:
*
City, State, and Zip Code:
*
Phone Number
*
Start Date
*
MM slash DD slash YYYY
End Date
MM slash DD slash YYYY
Hrs/Week:
*
Starting Rate:
*
Ending Rate:
*
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.
*
May we contact this employer?
*
Yes
No
WORK EXPERIENCE (2)
Company:
Job Title:
Name of last supervisor:
Address:
City, State, and Zip Code:
Phone Number
Start Date
MM slash DD slash YYYY
End Date
MM slash DD slash YYYY
Hrs/Week:
Starting Rate:
Ending Rate:
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.
May we contact this employer?
Yes
No
WORK EXPERIENCE (3)
Company:
Job Title:
Name of last supervisor:
Address:
City, State, and Zip Code:
Phone Number
Start Date
MM slash DD slash YYYY
End Date
MM slash DD slash YYYY
Hrs/Week:
Starting Rate:
Ending Rate:
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.
May we contact this employer?
Yes
No
WORK EXPERIENCE (4)
Company:
Job Title:
Name of last supervisor:
Address:
City, State, and Zip Code:
Phone Number
Start Date
MM slash DD slash YYYY
End Date
MM slash DD slash YYYY
Hrs/Week:
Starting Rate:
Ending Rate:
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.
May we contact this employer?
Yes
No
WORK EXPERIENCE (5)
Company:
Job Title:
Name of last supervisor:
Address:
City, State, and Zip Code:
Phone Number
Start Date
MM slash DD slash YYYY
End Date
MM slash DD slash YYYY
Hrs/Week:
Starting Rate:
Ending Rate:
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.
May we contact this employer?
Yes
No
I certify that all answers and statements on this application are true and complete to the best of my knowledge. I understand that, should this application contain any false or misleading information, my application may be rejected or my employment with this company terminated.
Signature
*
Today's Date
MM slash DD slash YYYY
CAPTCHA
Name
This field is for validation purposes and should be left unchanged.
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