Online Job Application
 

Social Security Number*:       Date of Application:

Date of Birth:       Place of Birth:     Telephone Number*:

Email Address*:

Last Name:    First:       Middle:

Street Address:  

City:    State:       Zip:

Drivers License # :    State:       Exp. Date:

Are you over 18 Years of Age ?   

WHO TO NOTIFY IN CASE OF AN EMERGENCY:

Name:    Phone:   

Address:    Relationship:

Position Applied for:    

Education:

Highest Grade Completed:     College:

Elementary School:
Address:

High School:    Did you Graduate :   
Address:

College:    Did you Graduate :   
Address:

Other School:    Did you Graduate :   
Address:

 

*Work Experience (Start with your present or last job)*
May we contact your former Employers?


Employer:

Dates Worked:

Address:
                   
Supervisor Name & Number:

Work Performed:
                   
Reason for leaving:
                   


Employer:

Dates Worked:

Address:
                   
Supervisor Name & Number:

Work Performed:
                   
Reason for leaving:
                   



Employer:

Dates Worked:

Address:
                   
Supervisor Name & Number:

Work Performed:
                   
Reason for leaving:
                   


Have you ever applied to this Company before?       If Yes, When?   

MILITARY SERVICE:

Branch of U.S. Military Service:
Served To/From:             Type of Discharge:

National Guard:       Date Obligation Ends :      
Date of Discharge:           

Availability:

Are you interested in Full or Part Time Employment ?

Are you able to work all shifts ?

Do you have transportation that will allow you to get back & forth to work?

PERSONAL REFERENCES WHO ARE NOT RELATIVES:

Name:   Years Acquainted:   
Address:    Phone:

Name:   Years Acquainted:   
Address:    Phone:

Name:   Years Acquainted:   
Address:    Phone:

 

APPLICANT QUESTIONAIRE:

Do you currently have a Valid Driver's License?

Do you currently have any points against your Driver's License?
If yes, list violations, dates, and points as accurately as possible:

Has you Driver's License ever been suspended or revoked?
If yes, list violations, dates, and points as accurately as possible:

List any accidents you may have had in the last 10 years. Include dates and if you were issued a citation:

List any traffic citations you may have received in the last 10 years :

Have you ever been charged with a criminal offense ?
*Includes misdemeanors, felonies, and/or crimes of moral turpitude or sexual offenses.
If yes, list charges, dates, and disposition as accurately as possible:

 

Applicant’s Statement: To determine my qualifications for employment, I authorize this company to conduct an investigation of my application. I understand that any false or misleading information furnished by me or this application for employment may result in rejection of the application, or if employed by this company, in the termination of employment.

Electronic Signature, please type Full Name in Box Below.
By Signing this application, you are agreeing to the Applicant's Statement listed above.


***NOTE: If you leave the EMAIL BLANK, your application will NOT be submitted***

You May Also Print this Application and drop off at our Steubenville location!


 

For More Information
On Customized
Security Solutions”

 

CONTACT US TODAY
800-457-9977
 
   
Jefferson Security Services   *  Ohio Office   *   (740) 283-3681   *   (800) 457-9977   *   West Virginia Office   *   (304) 748-1759  *   Copyright 2011 Jefferson Security Services.  All Rights Reserved