Application For Employment

Personal Information

Name

Present Address

Permanent Address



Employment Desired

Type of Employment Desired: Full Time  Part Time  Temporary  Internship

Are you currently employed?

YESNO

If so, may we inquire of your present employer?

YESNO

If YES, provide work # and best time to call:

Have you ever filed an application here before?

YESNO  

Have you ever worked for Willo Security before?

YESNO  

Proof of work eligibility will be required upon employment. Are you authorized to work in the U.S.?

YESNO

Have you ever been convicted of a felony?

YESNO  

Will you work nights, weekends, and overtime if required?

YESNO

Can you perform the essential functions of the job for which you are applying with or without accommodation?

YESNO


Education

List last three (3) schools attended, starting with the most recent.




General

U.S Military Or Naval Service?

YESNO 

Are you currently enrolled in the National Guard or Reserves?

YESNO

In Case Of Emergency Notify


Former Employers

List your last four (4) employers, assignments, or volunteer activites, starting with the most recent.

Starting Hourly Rate/Salary:

$ per

Final Hourly Rate/Salary:

$ per

May We Contact for Reference?

YESNOLATER


Starting Hourly Rate/Salary:

$ per

Final Hourly Rate/Salary:

$ per

May We Contact for Reference?

YESNOLATER


Starting Hourly Rate/Salary:

$ per

Final Hourly Rate/Salary:

$ per

May We Contact for Reference?

YESNOLATER


Starting Hourly Rate/Salary:

$ per

Final Hourly Rate/Salary:

$ per

May We Contact for Reference?

YESNOLATER


Language Skills

List any foreign language(s) and check the box that best describes your proficiency level.

Read: FULLMODERATEBASIC

Write: FULLMODERATEBASIC

Speak: FULLMODERATEBASIC


Read: FULLMODERATEBASIC

Write: FULLMODERATEBASIC

Speak: FULLMODERATEBASIC


Read: FULLMODERATEBASIC

Write: FULLMODERATEBASIC

Speak: FULLMODERATEBASIC


Skills and Qualifications

Summarize special skills and qualifications acquired from employment, or other experiences that may qualify you for work with our organization.


References

(Below, please list three people not related to you, whom you have known at least one year)




Professional, Trade, Business or Civic Associations and Any Offices Held

Exclude memberships that would reveal sex, race, religion, national origin, age ancestry, disability, or other protected status.


Certifications, Special Accomplishments and/or Awards


Additional Information

List any additional information you would like us to consider.


Disclaimer and Signature

I certify that I have read and understood all of this employment application.
I give the Employer the right to investigate all references and confirm the accuracy of the information I have provided herein. I hereby release from any and all liability the Employer and its representatives for seeking such information and all other former employers, schools, persons, corporations, organizations and other reference sources for furnishing such information.

I understand that if I am extended an offer of employment, I may be required to a submit to a complete physical examination, including blood and/or urine drug testing, to determine my ability to perform the essential functions of the job, and that any offer is conditioned upon the results of the examination. I authorize the examining health care provider to disclose to the Employer the results of such examination.

I hereby certify that the above information is true and complete and agree that any false information, misrepresentations, or material omissions in the application and interview process, including any given at the time of my post-offer pre-employment physical may be cause for rejection or may be cause for subsequent dismissal if I am hired.

Furthermore, I understand that if employed, just as I will be free to resign at any time, the Employer reserves the right to terminate my employment at any time, with or without cause and without prior notice. I understand that no representative of the Employer has the authority to make any assurances to the contrary.

The Employer is an equal opportunity employer. The Employer does not discriminate in employment and no question on this application is used for the purpose of limiting or excluding any applicant’s consideration for employment on a basis prohibited by local, state or federal law.

This application is current for only ninety (90) days. At the conclusion of this time, if I have not heard from the Employer and still want to be considered for employment, it will be necessary for me to fill out a new application.