Employment Application "*" indicates required fields Step 1 of 5 20% First Name* Last Name* MIddle Name Social Security #* Today's Date* MM slash DD slash YYYY Address* City* State* ZIP* Mobile Phone*Email* REFERENCESReference #1 (this is a personal or professional reference and not related to you) First & Last Name* Phone* Relationship* Reference #2 (this is a personal or professional reference and not related to you) First & Last Name Phone Relationship Reference #3 (this is a personal or professional reference and not related to you) First & Last Name Phone Relationship WORK AVAILABILITYWORK AVAILABILITY (COMPLETE SECTION BASED ON YOUR CURRENT DAYS/HOURS OF WORK AVAILABILITY)SUNDAY* Any shift First Shift (Day) Second Shift (Evening) Third Shift (night) MONDAY* Any shift First Shift (Day) Second Shift (Evening) Third Shift (night) TUESDAY* Any shift First Shift (Day) Second Shift (Evening) Third Shift (night) WEDNESDAY* Any shift First Shift (Day) Second Shift (Evening) Third Shift (night) THURSDAY* Any shift First Shift (Day) Second Shift (Evening) Third Shift (night) FRIDAY* Any shift First Shift (Day) Second Shift (Evening) Third Shift (night) SATURDAY* Any shift First Shift (Day) Second Shift (Evening) Third Shift (night) Are you looking for FULL TIME or PART TIME position?* NOTE: FULL-TIME STATUS BEGINS AT 32 HRS. WEEKLYWhen are you available to start?* MM slash DD slash YYYY Are you available to work HOLIDAYS/OVERTIME?* YES NO Do You Have Your Own Transportation?* YES NO Do you have a valid driver’s license?* YES NO Some locations may require you to use your personal vehicle while on duty. Will this be a problem?* YES NO If hired, how would you like to be paid?* Direct Deposit Check NOTE: Payday is weekly **$10.00 Processing Fee will be deducted weekly (from paycheck) if receiving a printed checkHave you ever served in U.S. Military?* YES NO If yes are you currently active or in the reserves?* YES NO Have You Ever Been Laid Off Or Terminated From Work?* YES NO If Yes, Please Explain BelowHave You Ever Been Convicted Of a Felony Or Misdemeanor?* YES NO If Yes, Please Explain BelowPlease List Any Specialized Training, Skills, Internships, Certifications, etc…Explain why you want to work for Harrisburg Security, Inc. and how you can help the company (if hired). Employment HistoryEmployer #1 Employer Name, Address & Phone Number*Duties Performed*Start Date* MM slash DD slash YYYY End Date* MM slash DD slash YYYY I am still currently working at this job* YES Job Title* Hourly Rate/Salary* Reasons for leaving* May we contact this employer?* YES NO Employer #2Employer Name, Address & Phone NumberDuties PerformedStart Date MM slash DD slash YYYY End Date MM slash DD slash YYYY I am still currently working at this job YES Job Title Hourly Rate/Salary Reasons for leaving May we contact this employer? YES NO Employer #3Employer Name, Address & Phone NumberDuties PerformedStart Date MM slash DD slash YYYY End Date MM slash DD slash YYYY I am still currently working at this job YES Job Title Hourly Rate/Salary Reasons for leaving May we contact this employer? YES NO Education HistoryHigh School Completed* YES NO GED or Equivalent completed?* YES NO High School Name* College*Field of StudyNumber of years attendedWhen did you graduate?*If you did not graduate, let us know how many years you completedOther programs / certificates (specify)ALL THE INFORMATION I HAVE LISTED IN THIS APPLICATION IS TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE.* YESPlease complete your full name* You acknowledge that you and only you completed this employee application Δ
