Full NameDate of ApplicationStreet AddressApt/SuiteCityState: PAZip CodePhoneE-mailFull SSNDOB (For Background Check)
Are you 18 years of age or older?
Yes
No
Are you legally authorized to work in the United States?
Yes
No
Do you possess a valid Pennsylvania Driver's License?
Yes
No
Have you ever been convicted of a felony or a disqualifying misdemeanor?
Yes
No
Do you possess a current PA Act 235 (Lethal Weapons Training) Certification?
Yes
No
N/A
If Yes to Act 235, provide Certification NumberExpiration DatePosition & Availability: Position Applied ForDesired Pay Rate ($/hr)
Type of employment desired
Full-Time
Part-Time
Seasonal / Temporary
Availability
Days
Evenings
Nights
Weekends
Holidays
Education & Military Background: High School Diploma or GED Recipient?
Yes
No
Name of School / City / StateCollege / University / Trade School NameDegree / Certification Earned
Are you a veteran of the U.S. Armed Forces?
Yes
No
BranchPrevious Employment History (List Last 2 Employers): Employer 1 Company NameJob TitleDates Employed (Mo/Yr)Reason for LeavingEmployer 2: Company NameJob TitleDates Employed (Mo/Yr)Reason for LeavingI certify that all answers and statements given true, complete, and correct to the best of my knowledge. I understand that any omission or misrepresentation of facts is cause for denial of employment or immediate dismissal.
I hereby authorize this Security Organization and its agents to conduct a comprehensive criminal history background check, fingerprinting (if applicable under PA law), drug screening, and verification of previous employment and certifications. Submit