Education Level
Some High School High School Grad Some College College Grad Postgraduate Degree Other - Please specify

Type of position
Security Officer Lobby Ambassador Public Relations/Customer Service Supervisor Managerial Administrative Accounting Other - Please specify

Date available to start work

Salary desired/expected

Working restrictions
No restrictions Weekends Overtime Weekdays

I was referred by
Newspaper Ad Job Fair School UPS Employee Employment Service Other - Please specify

I would like to work in
Los Angeles West Los Angeles Orange County Inland Empire San Diego San Francisco Other - Please specify

I am interested in the following shifts:
Any Shift
Day
Swing
Grave

If hired, can you provide proof that you are at least 18 years of age?
Yes  No

If hired, can you provide proof of your legal right to work in the United States?
Yes  No

If hired, are you willing to take a medical exam related to the essential functions of the job, which includes drug screening?
Yes  No

Will you need reasonable accommodation to perform any of the essential functions of the job?
Yes  No

Some positions may require bonding. Are you bondable?
Yes  No

Have you ever been bonded?
Yes  No

Have you ever applied at this company before?
Yes  No

If yes, when?

Have you ever worked at this company before?
Yes  No

If yes, when?

Do you have a valid driver's license?
Yes  No

Have you ever been convicted of a crime before? (Convictions are not an automatic disqualification from employment.)
Yes  No

As part of our hiring process, we may ask for a copy of your last performance appraisal.
Yes  No

Please Enter Your Last Three Jobs, beginning with most recent:

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Company Name:		Start:		End:
Address		Job Title:		Ending Salary:
Describe Duties:		Telephone #		Reason for Leaving
Company Name:		Start:		End:
Address		Job Title:		Ending Salary:
Describe Duties:		Telephone #		Reason for Leaving
Company Name:		Start:		End:
Address		Job Title:		Ending Salary:
Describe Duties:		Telephone #		Reason for Leaving

Education/Military Information
> >

School or Institution	Name and City/State of School	Highest Grade Completed and/or Degree
Elementary
High School
College

Honors or Awards Received:

Professional Licenses or Certificates:

Hobbies/Special Interests:

Dates of US Military Service:
From:
To:

Branch/Rank Held:

Reserve Status:

References

Name and Address	Telephone	Occupation	Years Known

Applicant's Certification and Agreement:
I authorize and request that my current and all former employers and those people I have listed as references furnish STRATUS SECURITY SERVICES with information about my employment record, including a statement of the reason for the termination of my employment, work performance, abilities and other qualities pertinent to my qualifications for employment; hereby releasing them and STRATUS SECURITY SERVICES from any and all liability and responsibility arising from any information provided.

This shall authorize the procurement of a consumer report by STRATUS SECURITY SERVICES as part of the pre-employment background investigation. If hired, this authorization shall remain on file and shall serve as an ongoing authorization for STRATUS SECURITY SERVICES to procure consumer reports at any time during my employment period.

I understand that any offer of employment with STRATUS SECURITY SERVICES is contingent upon my passing any required physical examinations. I acknowledge that it is the policy of STRATUS SECURITY SERVICES that all applicants submit a sample of urine for chemical or other analysis. I further understand that the purpose of this analysis is to determine or rule out the presence of non-prescribed or prohibited controlled substances in my urine. I hereby consent to this request for a urine sample and agree to participate in the testing program.

In consideration of my employment, I agree to comply with the policies, rules, regulations and procedures of STRATUS SECURITY SERVICES. I understand that I do not have a contract of employment with STRATUS SECURITY SERVICES; that my employment with be at-will and is not for a definite duration and that my employment can be terminated with or without cause or notice, at any time, at the option of either the Company or myself. I certify that the information contained in this application is true and complete to the best of my knowledge and belief. I understand that any misrepresentation or omission of fact in this application will be cause for refusal of employment or, if employed, termination from STRATUS SECURITY SERVICES.

I agree  I do not agree