Application for Employment This application must be filled out in it's entirety for us to review it. If an item does not apply to you simply state "N/A" (not applicable). If you would like to print this application and fax it in please click here to download a pdf version of our application form and fax it to 603-382-0030. Personal Information First Name: Middle Initial: Last Name: Present Address (NO P.O. Boxes) Street No. & Name: Apt# (if any): City: Choose State Connecticut Maine Massachusetts New Hampshire Rhode Island Vermont Postal Code: Email Address Home Phone w/area code: Mobile Phone: Pager: Are you 18 years or older? Please select Yes No Are you either a U.S. Citizen or Alien authorized to work in the U.S.? Please Select Yes No In case of emergency notify: Relationship to Applicant: Address: City: Phone:   Desired Employment Position Date you can start? Salary Desired? Are you currently employed? Please Select Yes No Not Applicable If yes, may we contact your current employer? Please Select Yes No Not Applicable Have you ever applied to this company before? Please Select Yes No Not Applicable If yes, when? Have you ever worked for this company before? Please Select Yes No Not Applicable Name of your last supervisor with this company? Reason for leaving? How were you referred to this company? Please Select Employment Agency State Employment Agency Newspaper Ad College Placement Service Friend Walk In Other Please List your last (3) Three Employers Name of Present or Last Employer: Address: City: State: Zip Code: Starting Date: Ending Date: Job Title: Starting Salary: Ending Salary: May we contact your supervisor? Please Select Yes No Name of Supervisor: Supervisor Contact Number: Description of work: Reason for leaving: Name of Employer: Address: City: State: Zip Code: Starting Date: Ending Date: Job Title: Starting Salary: Ending Salary: May we contact your supervisor? Please Select Yes No Name of Supervisor: Supervisor Contact Number: Description of work: Reason for leaving: Name of Employer: Address: City: State: Zip Code: Starting Date: Ending Date: Job Title: Starting Salary: Ending Salary: May we contact your supervisor? Please Select Yes No Name of Supervisor: Supervisor Contact Number: Description of work: Reason for leaving: Education High School Address # Yrs. Attended? Did you Graduate? Please Select Yes No Year Graduated Please Select 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 Subjects Studied College Address # Yrs. Attended? Did you Graduate? Please Select Yes No Year Graduated Please Select 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 Subjects Studied Trade/Business Address # Yrs. Attended? Did you Graduate? Please Select Yes No Year Graduated Please Select 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 Subjects Studied Other Address # Yrs. Attended? Did you Graduate? Please Select Yes No Year Graduated Please Select 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 Subjects Studied General Subjects of Study or Research Work: Special Training: Special Skills: Service Record Branch of Service: Discharge Rank: Present Membership in National Guard Services: Date Obligation Ends: References Please give the names of three (3) persons you are not related to, whom you have known at least one (1) year: Reference Name: Reference Address: Reference Phone #: Years Acquainted: Reference Name: Reference Address: Reference Phone #: Years Acquainted: Reference Name: Reference Address: Reference Phone #: Years Acquainted: Special Questions Do you have any physical limitations that preclude you from performing any work which you are being considered? Please Select Yes No If yes, what can be done to accommodate your limitations? Have you ever been arrested for any reason? Please Select Yes No If yes, please explain: Have you ever been summoned to appear in court? Please Select Yes No If yes, please explain: Have you ever been convicted of a felony or misdemeanor? Please Select Yes No If yes, please explain: Do you have a valid state issued pistol permit? Please Select Yes No If yes, which state issued the permit: What is the License Number: Do you have a state issued Armed Guard License: Please Select Yes No If yes, what state issued the license? Authorization "I certify that the facts contained in this application are true and complete to the best of my knowledge and understand that, if employed, falsified statements on this application shall be grounds for dismissal. I authorize investigations of all statements contained herein and the references listed to give you any any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise and release all parties from their liability for any damage that may result from furnishing the same to you." I, , so hereby authorize Advanced Security Services and Investigations Inc., and/ or it's agent to obtain/review information contained in documents pertaining to my employment with your organization, and what is contained in this application concerning the following: Criminal History Motor Vehicle Driver History Motor Vehicle License Check Credit Reports Educational Backgrounds Military History Organization Entry Date: Medical Records I understand and agree that, if hired, my employment is for no definite period and may, regardless of date of payment of my wages and salary, be terminated at any time without prior notice. This information is to be used in determining my eligibility as a candidate for a position with Advanced Security Services Inc.   Signature: Date: Submit Application