• Employment History

  Read First: Please list all jobs beginning with your present or last employer. Account for all time periods including unemployment, self-employment, and military service. If space is insufficient, list on separate page. This section must be completed even if supplemented by a resume.
• Company name:
  Street Address:
  City, State, and Zip:
  Telephone:
  Dates of Employment:
  From
  To    
• Position:
  Duties (be specific):
• Starting Salary:
  Ending Salary:
  
  
  Supervisor's Name:
  Reason for Leaving (be specific):
• Company name:
  Street Address:
  City, State, and Zip:
  Telephone:
  Dates of Employment:
  From
  To    
• Position:
  Duties (be specific):
• Starting Salary:
  Ending Salary:
  
  
  Supervisor's Name:
  Reason for Leaving (be specific):
• Company name:
  Street Address:
  City, State, and Zip:
  Telephone:
  Dates of Employment:
  From
  To    
• Position:
  Duties (be specific):
• Starting Salary:
  Ending Salary:
  
  
  Supervisor's Name:
  Reason for Leaving (be specific):
• Company name:
  Street Address:
  City, State, and Zip:
  Telephone:
  Dates of Employment:
  From
  To    
• Position:
  Duties (be specific):
• Starting Salary:
  Ending Salary:
  
  
  Supervisor's Name:
  Reason for Leaving (be specific):
• Company name:
  Street Address:
  City, State, and Zip:
  Telephone:
  Dates of Employment:
  From
  To    
• Position:
  Duties (be specific):
• Starting Salary:
  Ending Salary:
  
  
  Supervisor's Name:
  Reason for Leaving (be specific):
• Company name:
  Street Address:
  City, State, and Zip:
  Telephone:
  Dates of Employment:
  From
  To    
• Position:
  Duties (be specific):
• Starting Salary:
  Ending Salary:
  
  
  Supervisor's Name:
  Reason for Leaving (be specific):
• If presently employed, may we contact your employer to verify employment? Yes No

• Additional Information

  Please answer each question to the best of your ability. If not, mark with N/A.

• If presently employed, why do you desire to change your position?
• What shifts and days are you available to work?
• What are your career goals?
• Use this space to provide any relevant information about yourself, your background, or your skills (including computer skills) that you feel we should take into account in considering your application:

• Professional References

  (i.e. co-workers, managers, teachers, etc. No family/friends)

• Name:	Title:	Organization:	Phone:
  Name:	Title:	Organization:	Phone:
  Name:	Title:	Organization:	Phone:

• Certification

• To fulfill our commitment to a safe and productive environment, Silver Shield Security will not permit the unauthorized use or possession of alcohol on Company premises at any time, nor will we knowingly permit employees to work while under the influence of alcohol or drugs. Silver Shield Security substance abuse policy, as set forth in the Company’s policies and procedures, delineates in detail the Company’s expectations and the employee’s responsibilities.

  I certify that I have answered truthfully and have not knowingly withheld any information relative to my application. I understand that any misrepresentation of this application will result in my not being considered for employment. I further understand that, if accepted for employment, any misrepresentation that becomes known to Silver Shield Security will be cause for termination. I authorize the employers and supervisors listed as references to give Silver Shield Security any and all information regarding my previous employment and any pertinent information they may have concerning me. I release Silver Shield Security and previous employers and supervisors from liability for any damage that may result from furnishing information to Silver Shield Security.

  In consideration of my employment I agree to conform to the instructions, rules, and policies of Silver Shield Security. My employment and compensation can be terminated at any time, with or without cause and with or without notice, at the option of either Silver Shield Security or myself. I understand that no representative of Silver Shield Security, other than the President, has any authority to enter into any agreement for employment for any specified period of time, or to make any agreement contrary to the foregoing.

  Applicant’s Signature: Date:

• Agreement, Authorization, and Consent for Release of Background Information

  PLEASE TYPE OR PRINT

• I,  
   Last Name  
   First Name  
   Middle Name  
   (Please include Jr., Sr., II, etc.)

  understand that in conjunction with my application for employment, work to be performed under contract, promotion, reassignment, and/or retention (“Employment”), Silver Shield Security will use the services of an outside agency to research and verify the information I have provided on my application for employment including my personal background, character, professional standing, work history and qualifications. This agency will provide a written report of its findings to Silver Shield Security. Silver Shield Security uses AbsoluteHire, a consumer-reporting agency, as an agent to perform its Employment related background investigations.

  AbsoluteHire will utilize various sources of information it deems appropriate including but not limited to: credit reporting agencies, workers compensation records including any and all injuries in compliance with the Federal ADA Act, department of motor vehicle records, criminal conviction records, current and former employers, military records, education records, professional and personal references. I agree, authorize and consent to the release and disclosure of any and all information including but not limited to the above to Silver Shield Security, and AbsoluteHire.

  I agree, authorize and consent to the procurement of a Consumer Report and/or an Investigative Consumer Report and understand that it may contain information about my credit worthiness, credit standing, credit capacity, character, general reputation, personal characteristics, or mode of living. This authorization in original or copy form shall be valid for my term of Employment from the date indicated next to my signature. According to the Fair Credit Reporting Act, I will be notified by Silver Shield Security if Employment is denied because of information obtained from a Consumer Reporting Agency. Additionally, I understand that if requested within 60 days, I will be given a full and accurate disclosure as to the nature and substance of all information provided to Silver Shield Security. I further understand that I may request a copy of the report, and that when doing so, proper identification will be required and I should direct my request to: AbsoluteHire, 3000 Lava Ridge Ct, Roseville, CA 95661. I understand that residents of all states will automatically receive a copy of the report if an adverse action is taken regarding the employment application, or upon request as outlined herein.

• CHECK THIS BOX IF you are applying for work with a California, Minnesota or Oklahoma based employer and you would like a copy of your Consumer Report if one is prepared in the investigation of your background. CA Codes 1785.20.5 & 1786.16(a)(5)(b)(1), MN Code 13C Subdivision 2, OK Code 24 O.S. §148

• LAW ENFORCEMENT AGENCIES AND OTHER ENTITIES FOR POSITIVE IDENTIFICATION PURPOSES REQUIRE THE FOLLOWING INFORMATION WHEN CHECKING PUBLIC RECORDS. IT IS CONFIDENTIAL AND WILL NOT BE USED FOR ANY OTHER PURPOSES. PLEASE PRINT CLEARLY.

   
   Signed  
   Today's Date
   
   Name as it appears on your driver’s license  
   Position Applied For
   
   Social Security Number  
   Date of Birth  
   Driver’s License Number  
   State
  Other names you have used, or are also known as, including maiden name, name changes and any aliases:

  PLEASE PROVIDE ALL RESIDENTIAL ADDRESSES FOR THE PAST 7 YEARS

  Current Address:  
   Street Apt.#  
   City  
   State  
   Zip Code  
   From / 
   To
  Former Address:  
   Street Apt.#  
   City  
   State  
   Zip Code  
   From / 
   To
  Former Address:  
   Street Apt.#  
   City  
   State  
   Zip Code  
   From / 
   To

The purpose of this form is to notify me that a Consumer Background Report will be conducted on me in the course of consideration for employment with or through my prospective employer, Silver Shield Security.

I understand that this report may be used to make decisions about my employment, including one or more of the following: hiring, firing, promotion, reassignment and access to facilities. According to the Fair Credit Reporting Act, I am entitled to know if employment will be and is ultimately denied because of information obtained by my prospective employer from a consumer-reporting agency.

The investigation will be conducted by Parkin Security Consultants, 160 Albright Way, Los Gatos, CA 95032, phone 888-931-9900. I understand my prospective employer has asked them to perform a background check on me and to prepare a report that will include a social security record check and the following searches for which I give my specific consent. I hereby authorize all public and private record holders of such information to release same to Parkin Security Consultants.

I understand that I have the right to inspect the report at the investigative agency's offices during normal business hours and after reasonable notice to the agency. I can also inspect the report by certified mail or by telephone. I must show proper identification, pay for any costs involved with the inspection and have the right to be accompanied by one other person who must also show proper identification. The investigative agency will explain any of the information in the report and will provide a written explanation of any coded information. I understand that I may request additional information about the nature and scope of the investigation and a summary of my rights under the consumer reporting laws.

I release Silver Shield Security and Parkin Security Consultants, Inc., their employees, officers and representatives and all other persons from all claims, liability, and damages that may result from negligently investigating, furnishing, communicating, reviewing, or evaluating information pursuant to this investigation and from the use of the report. This release means I am waiving claims for negligence, misrepresentation, emotional distress, invasion of privacy and any other negligent act. I expressly intend that this release is as broad and inclusive as is permitted by law. Also, if any portion of this release is held invalid, the balance will continue in full legal force.

I've read this Notice, Authorization and Liability Release and understand and agree with each of its terms. I voluntarily authorize Parkin Security Consultants, Inc. to conduct an investigation of me and to provide a report on their finding to Silver Shield Security. I authorize a FAX /photocopy of this release to be as valid as the original.