Security Management, LLC (the "Company") may request from a consumer reporting agency and for employment-related purposes, a "consumer report(s)" (commonly known as "background reports") containing background information about you in connection with your employment, or application for employment, or engagement of services (including independent contractor or volunteer assignments, as applicable).
HireRight, LLC ("HireRight") will prepare or assemble the background reports for the Company. HireRight is located and can be contacted at 3349 Michelson Drive, Suite 150, Irvine, CA 92612, (800) 400-2761, www.hireright.com.
The background report(s) may contain information concerning your character, general reputation, personal characteristics, mode of living, or credit standing. The types of background information that may be obtained include, but are not limited to: criminal history; litigation history; motor vehicle record and accident history; social security number verification; address and alias history; credit history; verification of your education, employment earnings history; professional licensing, credential and certification checks; drug/alcohol testing results history; military service; and other information.
Authorization
I hereby authorize Company to obtain the consumer reports described above about me.
Applicant Name
*
Application Date
*
Do you agree?
*
Agree
Disagree
General Information
Full Name
*
Other names used
Street Address
*
City, State
*
Phone number
*
Email
*
Date available
*
Desired salary
*
How often can you work?
*
Part-time
Full-time
No preference
Enter your birthdate
*
SSN
*
Do you have transportation to and from work?
*
Yes
No
Are you a citizen of the United States?
*
Yes
No
If no, are you authorized to work in The United States?
Yes
No
Have you ever worked for this company?
*
Yes
No
If yes, please provide the dates to the best of your knowledge.
Do you have any relatives or friends employed by this company?
*
Yes
No
If yes, please provide their name(s) and relationship:
When answering the following questions, do not include minor traffic infractions. Do not include ANY convictions for which the record has been sealed and/or expunged, and/or eradicated. Do not include any conviction for which probation has been successfully completed or otherwise discharged with the case having been judicially dismissed, and do not include any information regarding referrals to and/or participation in any pre-trial or post-trial diversion program. A conviction record will not necessarily bar you from employment. Factors such as age, time of offense, seriousness and nature of the violation, and rehabilitation will be considered.
Have you ever pleaded Guilty, No Contest, or been convicted of a misdemeanor or felony?
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Yes
No
Have you ever been arrested for any matter for which you are now out on bail, or have been released on your own recognizance, pending trial?
*
Yes
No
If you answered YES to either of the questions above, please provide the details for each, including case number and court where your case is/was handled:
*
Driving History
Driver's license #
*
State
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
License type(s)
*
Class A (CDL)
Class B (CDL)
Class C (CDL)
Class D (Chauffeurs)
Class E (Personal driver's license(Non-commercial))
Learner's Permit
Other
Expiration date
*
Have you ever had a license suspended or revoked?
*
Yes
No
If yes, please explain:
In the last five (5) years, have you plead Guilty, No Contest, or been convicted of any traffic violations?
Yes
No
If yes, please explain:
Places Of Residence
In the space below, please provide the address(es) at which you have taken residence during the last ten (10) years. Begin with current residence and account for all time, leaving no gaps.
From
*
To
*
Street address
*
City/state/zip
*
From
To
Street address
City/state/zip
From
To
Street address
City/state/zip
Education
High School:
*
City, State, Country
*
Date from
*
Date to
*
Did you graduate?
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Yes
No
Did you earn a diploma?
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Yes
No
College:
City, State, Country
Date from
Date to
Degree
Any other education?
References
Please list three (3) references. Please do not include family members.
Full name, Relationship, Company, Phone Number, and Address
*
Previous Employment
Company:
*
Phone:
*
Address:
*
Supervisor:
*
Job Title:
*
Starting Salary:
*
Ending Salary:
*
Responsibilities
*
Start date
*
End date
*
Reason(s) for leaving
*
May we contact your former employer for a reference?
*
Yes
No
Company:
Phone:
Address:
Supervisor:
Job Title:
Starting Salary:
Ending Salary
Responsibilities
Start date:
End date:
Reason(s) for leaving
May we contact your former employer for a reference?
Yes
No
Any other previous employers?
Have you ever been laid off or terminated from any job or position?
*
Yes
No
If yes, please explain
Have you ever been asked to resign in lieu of termination from any job or position?
*
Yes
No
Please explain any gaps in employment
I certify that the statements on all pages of this APPLICATION are true to the best of my knowledge. All information and documentation submitted in connection with this employment application, and in any interview, is true and correct.
It is understood and agreed upon that any misrepresentation by me in this application will be sufficient cause for cancellation of this application and/or separation from Security Management LLC service.
I give Security Management LLC the right to investigate all references and to secure additional information about me, if job-related. I hereby release from liability Security Management LLC and its representatives for seeking such information. I hereby release all other persons, corporations, or organizations for furnishing such information to Security Management LLC for the purpose of determining my suitability for employment.
I understand that my employment at Security Management LLC will be contingent upon the passing of a test for controlled substances.
Security Management LLC is an Equal Opportunity Employer. Security Management LLC does not discriminate in employment and no question on this application is used to limit or excuse any applicant's consideration for employment on a basis prohibited by local, state, or federal law.
Applicant Name
*
Application Date
*
Do you agree?
*
Agree
Disagree
I,
Applicant Name
*
, the undersigned, do hereby authorize Security Management LLC and/or its authorized representative(s) or employee(s), bearing this release or copy thereof, to obtain any information in your files pertaining to my previous employment and/or criminal history.
I hereby direct you to release such information upon the request of the bearer. This release is executed with full knowledge and understanding that the information is needed for employment purposes.
I hereby release you, as custodian of such records, from all liability for damages of any kind that may result because of compliance with this authorization and request for information, or any attempt to comply with it.
The information to be obtained is to be utilized to confirm records for possible employment with Security Management LLC at this facility.
Applicant Name
*
Application Date
*
Do you agree?
*
Agree
Disagree
*
indicates required fields