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IMPORTANT INSTRUCTIONS

Personal History Form Instructions

It is mandatory that all information requested be supplied in the manner specified. Each question on this application must be answered; leave no blanks. If a question does not apply, enter DNA. An incomplete application will not be accepted.

Read the form carefully.
List zip codes and area codes for all requested addresses and telephone numbers.
Print full names of all references: first name, middle name, and last name. If the reference has no middle name or initial, you may leave it blank.
Complete all the information on educational background. List all high schools attended and/or graduated from and all colleges attended.
When listing residence information, begin with your present residence and go back for the last ten years or since age fifteen.
When listing employment information, begin with your present employer and list all other employers. List actual work addresses not corporate office addresses. Each month and year must be accounted for. Be sure each address is accurate and complete. List periods of military service, including the name of your station or assignment, and your residence if you lived off the base. If you resided at an address other than your permanent home address while attending school, list it.
List relatives in the order requested. For deceased relatives, indicate “deceased” next to their name.
If there is not sufficient space to include all information required, place a photocopy of that page (8-1/2" X 11"), in proper sequence and complete the information.
Any false statements or omissions made on this questionnaire may cause your name to be removed from the eligibility list or be cause for immediate termination, if an appointment is made.
You are required to report within five days to Guardian Eagle Security Inc Human Resources Department (backgrounds) any changes to information on this Personal History Form. Failure to do so may cause your name to be removed from the eligibility list or be cause for immediate termination, if an appointment is made.

I have read and understand the instructions provided.

Applicant’s signature:

Date

Note:

Please allow the full day for this appointment as you will be photographed, fingerprinted, and given an in-depth background investigation interview. Business attire is strongly recommended.

EDUCATION

HIGH SCHOOL OR GED

NAME AND ADDRESS

Graduated (Yes or No)

YEARS COMPLETED

Course or Major

COLLEGE

NAME AND ADDRESS

Graduated (Yes or No)

YEARS COMPLETED

Course or Major

POST GRADUATE

NAME AND ADDRESS

Graduated (Yes or No)

YEARS COMPLETED

Course or Major

ADDITIONAL EDUCATIONAL AND/OR VOCATIONAL OR TECHNICAL TRAINING (ON-THE-JOB OR IN SCHOOL)

Details 1:

Description

Location

Dates :

To:

Details 2:

Description

Location

Dates :

To:

MILITARY

Are you a veteran of the military services?

Yes

If yes, what branch:

If yes, what training or experience might be relevant to the job for which you are applying

SKILLS

List any special skills or qualifications which were not covered under Work History or Education. (Examples: machines you can operate, typing speed, licenses you hold, achievements, professional, trade, business or civic activities and offices held.) (Exclude any organization which may reveal race, color, religion, sex, age, national origin, disability, or other protected status.)

REFERENCES

Have you worked or attended school under any other name?

Yes

If yes, give name(s):

Have you ever been fired from a job or asked to resign?

Yes

If yes, may we contact your present employer?

Yes

If yes, please explain:

Give three references, not relatives or former employers.

Name

Address

Phone

AFFIDAVIT

I hereby certify that the facts set forth in the above employment application are true and complete to the best of my knowledge. I understand that if employed, false or misleading information or omission in my application or interview(s) shall be considered reason for dismissal. I understand that if I am extended on offer of employment it may be conditioned upon my successfully passing a complete pre-employment physical examination. I consent to the release of any or all medical information as may be deemed necessary to judge my capability to do the work for which I am applying. I understand I may be required to successfully pass a drug screening examination. I hereby consent to a pre and /or post employment drug screen as a condition of employment, if required. I understand, also, that if I am employed by Guardian Eagle Security Inc or its affiliates (hereinafter referred to as “the Company”), I am required to abide by all rules and regulations of the Company and my employment is at will and can be terminated at any time at the option of either the Company or myself. I understand that an offer of employment and acceptance does not guarantee a specific schedule and/or a specific number of hours and that time worked may be adjusted upward or downward depending on the needs of the Company. I further understand that the Company does not have employment contracts. I understand that evidence of an acceptable driving record is mandatory for jobs requiring driving. I authorize investigation of all statements contained in this application, unless otherwise indicated, and I further authorize the Company to withhold from my pay an amount equal to the cost of replacing all property, including uniforms, lost, damaged, or not returned

Signature

Date

Disclosure to Employment Applicant Regarding
Procurement of A Consumer Report

In connection with your application for employment, we may procure a consumer report on you as part of the process of considering your candidacy as an employee. In the event that information from the report is utilized in whole or in part in making an adverse decision with regard to your potential employment, before making the adverse decision, we will provide you with a copy of the consumer report and a description in writing of your rights under the law.

Please be advised that we may also obtain an investigative report including information as to your character, general reputation, personal characteristics, and mode of living. This information may be obtained by contacting your previous employers or references supplied by you. Please be advised that you have the right to request, in writing, within a reasonable time, that we make a complete and accurate disclosure of the nature and scope of the information requested. Such disclosure will be made to you within 5 days of the date on which we receive the request from you or within 5 days of the time the report was first requested.

The Fair Credit Reporting Act gives you specific rights in dealing with consumer reporting agencies. You will find these rights summarized on the reverse side of this document.

By your signature below, you hereby authorize us to obtain a consumer report about you in order to consider you for employment.

Applicant’s Name:

Full Name

Applicant’s Address:

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Social Security Number:

Signature

RELEASE AUTHORIZATION

APPLICANT COMPLETE THE FOLLOWING

I. In connection with my application for employment, I understand that a consumer report or an investigative consumer report may be requested that will include information as to my character, work habits, performance, and experience, along with reasons for termination of past employment. I understand that as directed by company policy and consistent with the job described, you may be requesting information from public and private sources about my: workers’ compensation injuries, driving record, court record, education, credentials, credit, and references.

If company policy requires, I am willing to submit to drug testing to detect the use of illegal drugs prior to and during employment.

II. Medical and workers’ compensation information will only be requested in compliance with the Federal Americans with Disabilities Act (ADA) and/or any other applicable state laws. According to the Fair Credit Reporting Act, I am entitled to know if employment is denied because of information obtained by my prospective employer from a consumer reporting agency. If so, I will be notified and given the name and address of the agency or the source which provided the information.

III. I acknowledge that a telephonic facsimile (FAX) or photographic copy shall be as valid as the original. This release is valid for most federal, state and county agencies including the Minnesota Department of Labor.

IV. Minnesota, Oklahoma and California applicants only. If you want a copy of the reports(s) ordered, Check this box ❑. The report(s) will be sent by the reporting agency to you at the address below. The reports will be processed by: ADP Screening and Selection Services, 301 Remington Street, Fort Collins, Colorado 80524, 800/367-5933.

V. I hereby authorize, without reservation, any law enforcement agency, institution, information service bureau, school, employer, reference or insurance company contacted by GUARDIAN EAGLE SECURITY INC. or its agent, to furnish the information described in Section 1.

The following information is required by law enforcement agencies and other entities for positive identification purposes when checking public records. It is confidential and will not be used for any other purposes. I hereby release the employer and agents and all persons, agencies, and entities providing information or reports about me from any and all liability arising out of the requests for or release of any of the above mentioned information or reports.

Please print your full name

First Middle Last

Please print other names you have used

Home Address

Street Address Address Line 2 City State ZIP Code

Social Security Number

Date of Birth

The following states require sex and race to obtain information:
AL, AR, FL, GA, IA, IL, IN, MI, OR, TX, WI

Drivers License Number

State Issuing License

State / Province / Region

Name as it appears on license

Signature

Today’s Date

Job Application

IMPORTANT INSTRUCTIONS

Personal History Form Instructions

Note:

Guardian Eagle Security Inc and Affiliates

APPLICATION FOR EMPLOYMENT

PERSONAL DATA

GENERAL

WORK HISTORY

1. Employment Details :

2. Employment Details :

EDUCATION

MILITARY

SKILLS

REFERENCES

AFFIDAVIT

APPLICANT DATA RECORD (REQUIRED FOR GOVERNMENT REPORTING)

EQUAL EMPLOYMENT OPPORTUNITY INFORMATION

Disclosure to Employment Applicant Regarding
Procurement of A Consumer Report

RELEASE AUTHORIZATION

Supplemental Application for Security Officer/Guard

Guardian Eagle Security, Inc.

Navigation

Information

Opening Hours

Copyright ©2024 All rights reserved | Guardian Eagle Security Inc.

Job Application

IMPORTANT INSTRUCTIONS

Personal History Form Instructions

Note:

Guardian Eagle Security Inc and Affiliates

APPLICATION FOR EMPLOYMENT

PERSONAL DATA

GENERAL

WORK HISTORY

1. Employment Details :

2. Employment Details :

EDUCATION

MILITARY

SKILLS

REFERENCES

AFFIDAVIT

APPLICANT DATA RECORD (REQUIRED FOR GOVERNMENT REPORTING)

EQUAL EMPLOYMENT OPPORTUNITY INFORMATION

Disclosure to Employment Applicant Regarding Procurement of A Consumer Report

RELEASE AUTHORIZATION

Supplemental Application for Security Officer/Guard

Guardian Eagle Security, Inc.

Navigation

Information

Opening Hours

Copyright ©2024 All rights reserved | Guardian Eagle Security Inc.

Disclosure to Employment Applicant Regarding
Procurement of A Consumer Report