step 1 Application for Employment Full Name (Social Security Number #) Today's Date Address: Phone Number # Cellular Phone # Email Address Next step 2 References (Personal or Professional and NOT related to you) Reference 1 (First And Last) Phone # Relationship Reference 2 (First And Last) Phone # Relationship Reference 3 (First And Last) Phone # Relationship Back Next step 3 Work Availability (Complete Section Based On Your Current Days/Hours Of Work Availability) NOTE: THE BELOW SECTION SHOULD REFLECT YOUR PERSONAL AVAILABILITY AND NOT BASED ON ANY POSTED HSI JOB OPENING Sunday Any Shift1st Shift (Day)2nd Shift (Evening)3rd Shift (Night) Can Only Work: From AMPM To AMPM Monday Any Shift1st Shift (Day)2nd Shift (Evening)3rd Shift (Night) Can Only Work: From AMPM To AMPM Tuesday Any Shift1st Shift (Day)2nd Shift (Evening)3rd Shift (Night) Can Only Work: From AMPM To AMPM Wednesday Any Shift1st Shift (Day)2nd Shift (Evening)3rd Shift (Night) Can Only Work: From AMPM To AMPM Thursday Any Shift1st Shift (Day)2nd Shift (Evening)3rd Shift (Night) Can Only Work: From AMPM To AMPM Friday Any Shift1st Shift (Day)2nd Shift (Evening)3rd Shift (Night) Can Only Work: From AMPM To AMPM Saturday Any Shift1st Shift (Day)2nd Shift (Evening)3rd Shift (Night) Can Only Work: From AMPM To AMPM How Many Hours Per Week Do You Desire? FTPT NOTE: FULL-TIME STATUS BEGINS AT 32 HRS. WEEKLY Are you available to work HOLIDAYS/OVERTIME? YESNO Available to start working on (date) ASAP (As Soon As Possible) Do You Have Your Own Transportation? YESNO Do you have a valid driver’s license? YESNO Some locations may require you to use your personal vehicle while on duty. Will this be a problem? YESNO If hired, how would you like to be paid? Direct DepositCheck NOTE: Payday is weekly **$10.00 Processing Fee will be deducted weekly (from paycheck) if receiving a printed check Have you ever served in U.S. Millitary? YESNO If yes are you currently active or in the reserves? YESNO If You Are No Longer Active and/or Retired, Can You Provide a Copy Of Your DD214 (if needed)? YESNO Have You Ever Been Laid Off Or Terminated From Work? YESNO If Yes, Please Explain Below Have You Ever Been Convicted Of a Felony Or Misdemeanor? YESNO If Yes, Please Explain Below Please 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). Back Next step 4 EMPLOYMENT HISTORY HARRISBURG SECURITY, INC. Is Committed To Providing Equal Opportunity Employment To Employees Without Regard To Race, Religion, Creed, Age, Gender, Any Disability Unrelated To An Individual's Ability To Perform Adequately Or And Other Characteristics Protected By Law. NOTE: START WITH YOUR MOST RECENT OR CURRENT JOB AND INCLUDE PREVIOUS WORK EXPERIENCE. **Must Include No Less Than 7 Yrs Of Previous Work Experience (if applicable)** EMPLOYMENT HISTORY 1 Employer Details Employer Name Address Phone # Dates Employed Started (Month / Year) Ended (Month / Year) I am still currently working at this job Hourly Rate / Salary Starting Ending Duties Performed Job Title Reason for Leaving May we contact this employer? YESNO Name of Supervisor Shifts worked (Check all that apply) DAYSEVENINGSNIGHTS EMPLOYMENT HISTORY 2 Employer Details Employer Name Address Phone # Dates Employed Started (Month / Year) Ended (Month / Year) I am still currently working at this job Hourly Rate / Salary Starting Ending Duties Performed Job Title Reason for Leaving May we contact this employer? YESNO Name of Supervisor Shifts worked (Check all that apply) DAYSEVENINGSNIGHTS EMPLOYMENT HISTORY 3 Employer Details Employer Name Address Phone # Dates Employed Started (Month / Year) Ended (Month / Year) I am still currently working at this job Hourly Rate / Salary Starting Ending Duties Performed Job Title Reason for Leaving May we contact this employer? YESNO Name of Supervisor Shifts worked (Check all that apply) DAYSEVENINGSNIGHTS EMPLOYMENT HISTORY 4 Employer Details Employer Name Address Phone # Dates Employed Started (Month / Year) Ended (Month / Year) I am still currently working at this job Hourly Rate / Salary Starting Ending Duties Performed Job Title Reason for Leaving May we contact this employer? YESNO Name of Supervisor Shifts worked (Check all that apply) DAYSEVENINGSNIGHTS Back Next step 5 EDUCATION HISTORY School Name And Address Course or Field of Study Number of Years Attended Did you Graduate? YESNO G.E.D or Equivalent?YES YESNOCurrently Attending YESNOCurrently Attending All The Information I Have Listed In This Application Is True And Accurate To The Best Of My Knowledge. SIGNATURE: *THIS APPLICATION MAY BE COMPLETED AND RETURNED TO: 6475 MOREHEAD RD. HARRISBURG, NC 28075 EOE / DRUG-FREE WORKPLACE / BACKGROUND CHECKS CONDUCTED Back Δ
