Applicant Information

Full Name:

Date:

                       Last

First

M.I.

Address:

                       Street Address

Apartment/Unit #

City

State

ZIP Code

Phone:

E-mail Address:

Date Available:

Social Security No.:

Position Applied for:

Are you a citizen of the United States?

YES

NO

If no, are you authorized to work in the U.S.?

YES

NO

Have you ever worked for this company?

YES

NO

If so, when?

Have you ever been convicted of a felony?

YES

NO

If yes, explain:

1.       Barkley Security Agency has various schedules, which include working weekends and Holidays. Is this acceptable to you? Yes      No

2.       Security Guard duties require walking for long periods of time. Will this be a problem for you?  Yes    No

3.       Barkley Security that all ACCEPTED applicants be trained on the site you are assigned to and also be an orientation at the office. Is this acceptable to you?  Yes    No

4.       Do you understand that a Security Officer is not a POLICE OFFICER? Yes    No

5.       It will be your responsibility to get your schedule scheduled assignment on your own and it is not the responsibility of Barkley Security. DO you understand and accept this?  Yes   No  

Education

High School:

Address:

From:

To:

Did you graduate?

YES

NO

Degree:

College:

Address:

From:

To:

Did you graduate?

YES

NO

Degree:

Other:

Address:

From:

To:

Did you graduate?

YES

NO

Degree:

Personal  or Professional References

Providing this information means that you are giving Barkley Security Agency permission to contact all the references.

Full Name:

Relationship:

Company:

Phone:

Address:

Full Name:

Relationship:

Company:

Phone:

Address:

Full Name:

Relationship:

Company:

Phone:

Address:

Previous Employment

Company:

Phone:

Address:

Supervisor:

Job Title:

Starting Salary:

$

Ending Salary:

$

Responsibilities:

From:

To:

Reason for Leaving:

May we contact your previous supervisor for a reference?

YES

NO

Company:

Phone:

Address:

Supervisor:

Job Title:

Starting Salary:

$

Ending Salary:

$

Responsibilities:

From:

To:

Reason for Leaving:

May we contact your previous supervisor for a reference?

YES

NO

Company:

Phone:

Address:

Supervisor:

Job Title:

Starting Salary:

$

Ending Salary:

$

Responsibilities:

From:

To:

Reason for Leaving:

May we contact your previous supervisor for a reference?

YES

NO

Military Service

Branch:

From:

To:

Rank at Discharge:

Type of Discharge:

If other than honorable, explain:

Disclaimer and Signature

I certify that my answers are true and complete to the best of my knowledge.

If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release.

I further understand that if employed by Barkley Security Agency I will be required to abide by all their rules and procedures. Failure to do so could result in my termination of employment with Barkley Security Agency, Inc.

I understand that neither this document nor any other offer of employment from Barkley Security Agency or its representatives constitutes an employment agreement.

I consent to release of information about my ability and fitness for the position I have applied for by employers, schools, law enforcement agencies to investigate, personnel staffing specialists and other authorized employees of Barkley Security Agency.

Signature:

Date: