APPLICATION FOR EMPLOYMENT
Middleton Security Service
An Affirmative Action/Equal Opportunity Employer

Contact Numbers

Phone	1-(661)-322-5982
FAX	1-(661)-322-5995
http://www.MiddletonSecurity.com

POSITION APPLIED FOR: You must fill out all sections of this application completely and honestly. This information will be used to determine your eligibility for this position. All application materials become the property of Middleton Security Service and will not be returned.
PERSONAL INFORMATION

Name (Last, First, Middle Initial)
|

Social Security Number
____-___-____

Address (Street, City, State, Zip Code)
|

Home Phone Number
(____)-______-_________

Work Phone Number
(____)-______-_________

May we contact you at work?
___Yes ___No

Are you employed now
___Yes ___No

Age
___Less than 14 ___14-17 ___18 or over

Have you been employed under other names? ___Yes ___No
List Name(s):

Are you now or have been employed as A Security Guard ___Yes ___No
List company(s):

Have you ever been arrested ___Yes ___No
Have you ever been convicted of A crime ___Yes ___No

Are you related to anyone employed by Middletion Security Service ? ___Yes ___No
List name and relationship:

How did you find out about this job opening?

___ Web Page

___ Security Employee

___ Newspaper (identify) __________________

___ Other (Please Explain)__________________

Are you authorized to work in the U.S.? ___Yes ___No
If employed, you must show documents that prove your identity and employment eligibility as required by the Immigration Reform and Control Act of 1986.

EDUCATION & SKILLS:
Please list all education beginning with most recent. Indicate a diploma or degree, if completed, including GED if obtained.

Name & Location of School

# of yrs
complete

Graduated

Degree & Major

College

___Yes

If no, approx. number of credit hours completed

Other

___Yes

If no, approx. number of credit hours completed

Other

___Yes

If no, approx. number of credit hours completed

High School/GED

___Yes

If no, highest grade completed

Please List 3 Personal Reference's

Name________________________	Address____________________________________
Phone Number(____)_____-_______	Relationship____________________________________	Years Known____
Name________________________	Address____________________________________
Phone Number(____)_____-_______	Relationship____________________________________	Years Known____
Name________________________	Address____________________________________
Phone Number(____)_____-_______	Relationship____________________________________	Years Known____

SKILLS/CERTIFICATIONS/PROGRAMMING LANGUAGES: List technical or specialized skills/credentials relevant to this job, including driver's license (list type of license and name of state where issued), certifications, professional licenses, registrations held (include certifications/registration number and expiration date) and knowledge of any computer programming languages or specialized software or hardware.

Guard Card Info

Guard Card #____________________ Date Issued _____________ Expiration Date_____________

Do you Have any Disciplinary Actions ___No ___Yes (If Yes Please Explain)______________________________________________________

EMPLOYMENT HISTORY:List all employment including military and volunteer service starting with the most current position held. Show employment history for at least 10 years or from the time you left school. Explain gaps in employment history. You may attach a resume, but you must complete the employment section. This information will be used in reference checks. Failure to answer all items in the following sections may eliminate you from further consideration.

Dates Employed(month/year) From:_________ To:_________	Position Title
Salary Start: $_________ Final: $_________	Organization Name/Address
_____Full-Time _____Part-Time, hrs/wk_________	Supervisor's Name/Title/Phone:	Reason For Leaving:
May we contact for references ____Yes ____No
Duties:

Dates Employed(month/year) From:_________ To:_________	Position Title
Salary Start: $_________ Final: $_________	Organization Name/Address
_____Full-Time _____Part-Time, hrs/wk_________	Supervisor's Name/Title/Phone:	Reason For Leaving:
May we contact for references ____Yes ____No
Duties:

Dates Employed(month/year) From:_________ To:_________	Position Title
Salary Start: $_________ Final: $_________	Organization Name/Address
_____Full-Time _____Part-Time, hrs/wk_________	Supervisor's Name/Title/Phone:	Reason For Leaving:
May we contact for references ____Yes ____No
Duties:

PLEASE READ CAREFULLY AND SIGN - I certify that the above statements are correct. I understand that any false information (or omissions) in this application, or its supporting documents, will be sufficient grounds for refusal to hire me or termination without notice. I further understand that Middleton Security Service has the right to review my education, previous employment, driving, and criminal records and other background data.

APPLICANT'S SIGNATURE________________________________________DATE:________________________
____________________________________________________________________________________________________________