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Please print and complete the following form, then mail or fax it:

PRE-EMPLOYMENT APPLICATION

************************************************************

EVERGREEN SECURITY is an equal opportunity employer and will consider all applicants for all positions equally without regard to their race, sex, age, color, religion, national origin, veteran status, sexual orientation or any disability as provided in the Americans With Disabilities Act.

This application will be given every consideration, but its receipt does not imply that the applicant will be employed. Each question should be answered in a complete and accurate manner as no action can be taken on this application until all questions have been answered.

PERSONAL

Name___________________________________________________________ Home Phone (_____)_____________

Last First Middle

Present

Address________________________________________________________________________________________

No. Street City State Zip

Social Security No.___________________________________________ Are you over 18? Yes______ No_____

Are you a citizen of the U.S. or do you have the legal right to be employed in the U.S.? Yes________ No_______

Drivers License: State________ Number______________________________________ Valid? Yes______ No_______

EMPLOYMENT DESIRED

Are you seeking: Full time_________ Part time _______ Temporary or seasonal employment_________

Position Salary Date

Applying for_____________________________________ Desired____________________ Available_______________

Have you ever applied to our company before? Yes______ No______

Have you ever worked for our company before? Yes ______ No______

If your answer to either of the above questions is Yes, state when and where you applied and/or worked___________________________________________________________________________________________

_________________________________________________________________________________________________

How did you learn of our company and/or position? _______________________________________________________

_________________________________________________________________________________________________

Are you now, or do you expect to be, working in any other business or job? Yes______ No______

If yes, please explain________________________________________________________________________________

_________________________________________________________________________________________________

Are there any days or hours you would be unable or unwilling to work? Yes_____ No_____

If yes, please specify those days or hours you would be unable or unwilling to work? __________________________

________________________________________________________________________________________________

Have you filed any type of fraudulent claim against any of your present or past employers?

Yes______ No______ If yes, please explain____________________________________________________________

________________________________________________________________________________________________

Will you abide by the safety rules of this company? Yes______ No______

Have you ever been disciplined for violating safety rules or regulations? Yes______ No______

If yes, please explain________________________________________________________________________________

_________________________________________________________________________________________________

How many days of work (or school) have you missed in the last two years? _____________________________________

How many times have you been late for work (or school) in the last two years? __________________________________

EDUCATION

Names, Address Graduate Courses Studies

High School

Yes_____

No _____ Year:

Diploma:

College

Yes______

No ______ Year:

Degree/Major:

School or Special Training

Yes_____
No _____ Year:

Diploma or Certificate:

Are you currently attending or planning to attend school with a schedule, which changes each semester?

Yes_____ No_____ If yes, please explain _______________________________________________________________

MILITARY SERVICE

Have you ever served in the Armed Forces? Yes_____ No_____ If yes:

Service Date Date

Branch______________________________________MOS_________Entered_____________ Separated ___________

Membership in Security

National Guard or Reserves? Yes_____ No_____ Clearance: (circle) SECRET TOP SECRET

PROFESSIONAL LICENSES

Guard Clearance #______________________________ State ________________ Expiration _____________________

Handgun Permit # ______________________________ State ________________ Expiration _____________________

Private Detective # _____________________________ State ________________ Expiration _____________________

FIVE YEAR WORK HISTORY

List the names of employers in consecutive order with present or last employer listed first. Account for all periods of time including military service, part-time employment and any periods of unemployment for the past five years. If self-employed, give firm name and supply business references.

PLEASE START WITH MOST RECENT. DO NOT REFERENCE YOUR RESUME.

Employer	Name & Title of Supervisor	Dates Employed	Pay Start
Address	.	From:	$
City, State, Zip		To:	End
Phone	.	.	$
Job Title
Duties
Reason for Leaving

Employer	Name & Title of Supervisor	Dates Employed	Pay Start
Address	.	From:	$
City, State, Zip		To:	End
Phone	.	.	$
Job Title
Duties
Reason for Leaving

Employer	Name & Title of Supervisor	Dates Employed	Pay Start
Address	.	From:	$
City, State, Zip		To:	End
Phone	.	.	$
Job Title
Duties
Reason for Leaving

Employer	Name & Title of Supervisor	Dates Employed	Pay Start
Address	.	From:	$
City, State, Zip		To:	End
Phone	.	.	$
Job Title
Duties
Reason for Leaving

Employer	Name & Title of Supervisor	Dates Employed	Pay Start
Address	.	From:	$
City, State, Zip		To:	End
Phone	.	.	$
Job Title
Duties
Reason for Leaving

Employer	Name & Title of Supervisor	Dates Employed	Pay Start
Address	.	From:	$
City, State, Zip		To:	End
Phone	.	.	$
Job Title
Duties
Reason for Leaving

Employer	Name & Title of Supervisor	Dates Employed	Pay Start
Address	.	From:	$
City, State, Zip		To:	End
Phone	.	.	$
Job Title
Duties
Reason for Leaving

Employer	Name & Title of Supervisor	Dates Employed	Pay Start
Address	.	From:	$
City, State, Zip		To:	End
Phone	.	.	$
Job Title
Duties
Reason for Leaving

USE ADDITIONAL SHEETS IF NECESSARY

SUPPLEMENTAL EMPLOYMENT INFORMATION:

If you worked in any of your previous positions under another name, please give that name(s)

_________________________________________________________________________________________________

Are you presently employed Yes _____ No _____

May we contact your present employer? __________________

Have you ever been fired, or asked to resign, from a job? No _____Yes _____ If yes, please explain: _________________________________________________________________________________________________

_________________________________________________________________________________________________

Use the space below to describe why you are interested in working for our company and to list those skills and abilities which you feel particularly qualify you for a position with us. If you need more space, please continue on a separate sheet.

_________________________________________________________________________________________________

What are your career goals? _________________________________________________________________________

_________________________________________________________________________________________________

How many times have you moved in the last year? (If 2 or more, explain below)

_________________________________________________________________________________________________

Are you a member of any organization or any other activity, which requires your consistent attendance, which may interfere with employment here?
If yes, please explain:

_________________________________________________________________________________________________

Do you or would you have any problems getting to work on time, every day? Yes_____ No_____

If hired, will you also be working for another company? Yes _____ No _____

Do you have your own transportation? Yes _____ No ______

Do you have your own telephone? Yes _____ No _____

Would you be willing and able to perform all of the task required by the job for which you are applying? _______________

If no, please explain ________________________________________________________________________________

________________________________________________________________________________________________

Evergreen Security has a strict attendance policy. Would you have any problems meeting your attendance requirements? Yes _____ No _____

If yes, please explain: _______________________________________________________________________________

_________________________________________________________________________________________________

AFFIDAVIT

I certify that my answers to the foregoing questions are true and correct without any omissions of any kind whatsoever. I understand that if I am employed, any false, misleading or otherwise incorrect statements made on this application form or during any interviews may be grounds for my immediate discharge.

I hereby authorize the Company o contact any company or individual it deems appropriate to investigate my employment history, character and qualifications and I give my full and complete consent to their revealing any and all information they wish as a result of this investigation. In addition, I hereby waive my right to bring any cause of action against these individuals or companies for defamation, invasion of privacy or any other reason because of their statements.

I understand that, under Maryland la, an employer may not require or demand any applicant for employment or prospective employment or any employee to submit to or take a polygraph, lie detector or similar test or examination as a condition of employment or continued employment. Any employer who violates this provision is guilty of a misdemeanor and subject to a fine not to exceed $100.00.

Further, if hired, I may be required to work weekend, holiday and rotating shifts. Refusal or failure to work scheduled shifts shall be grounds for dismissal, without recourse on my part.

I agree that, if I am employed, I will abide by all the rules and regulations of the company. I understand that the taking of drug and alcohol tests, when given pursuant to company policy, are a condition of continued employment and refusal to take such tests when asked will be grounds for my immediate termination. I further understand that nobody in the Company is authorized to enter into any written or verbal employment contracts with me for any definite period of time without the express written consent of the President of the Company. I also understand that my employment is “at-will” and may be terminated at any time for any reason or no reason at all, with or without prior notice.

Applicant Signature __________________________________________ Date __________________

Witness ___________________________________________________ Date __________________

EVERGREEN SECURITY PATROL & INVESTIGATION

GENERAL WAIVER

Name: _________________________________________ SSN: _______-_____-________

Last First Middle

Address: __________________________________________________________________________

Street City State Zip

Date of Birth: ____________ Drivers License #: ___________________ State: _______

I hereby authorize a review and full disclosure of all records, or any part thereof, concerning myself by/to any duly authorized agent of Evergreen Security Patrol & Investigation, whether said records are public or private, and including those, which may be deemed to be of a privileged or confidential nature. The intention of this authorization is to provide information, which will be utilized for a pre-employment background investigation.

I authorize the full and complete disclosure of the records of educational institutions, and the records of commercial or retail mercantile establishments and retail credit agencies; employment and pre-employment records including background investigation reports, and efficiency ratings.

I authorize the National Personnel Records Center, St. Louis Missouri, or other custodian of my military records to release to Evergreen Security Patrol & Investigation information or photocopies from my military personnel records. This could include a copy of my DD Form 214, Report of Separation.

NOTE: Under the Fair Credit Reporting Act, you have the right to make a written request, within a reasonable period of time, for complete disclosure of additional information concerning the nature and scope of the investigation.

A photocopy/fax of this release form will be valid as an original hereof, even though the said photocopy/fax does not contain an original writing of my signature.

_______________________________________________________________________________
Signature and date

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Website Form Please print and complete the following form, then mail or fax it: PRE-EMPLOYMENT APPLICATION

PERSONAL

EMPLOYMENT DESIRED

EDUCATION

MILITARY SERVICE

PROFESSIONAL LICENSES

FIVE YEAR WORK HISTORY

EVERGREEN SECURITY PATROL & INVESTIGATION

GENERAL WAIVER

Website Form
Please print and complete the following form, then mail or fax it:

PRE-EMPLOYMENT APPLICATION