Name, (First, Middle, Last):

Address:

City: ,  State: ,  Zip Code:

Phone: (home): Phone (cell):

Emergency Contact Person: TELEPHONE:

Social Security number and Drivers License number can be provided upon interview with Priority Asset Protection. 

Drivers License Current? Yes No

Date Of Birth:

EMPLOYMENT DATA

Position applied for:

Salary desired: $per hour           Date available to start:

Hours available:             Full time or Part time:  

Are you an U.S. citizen, or do you have the legal right to be employed in the U.S.? Yes No

Have you ever been arrested or convicted of a felony (includes receiving probation or deferred adjudication)? Yes No

If Yes, Date and Place of Conviction, Type of Conviction : 

Have you ever been arrested or convicted of a misdemeanor (includes probation or deferred adjudication)? Yes No

If Yes, Date and Place of Conviction, Type of Conviction :        

Additional Comments (Conviction) Below:   

Are you employed now?  Yes No     If yes, may we contact your present employer? Yes No

EMPLOYMENT HISTORY (Starting with current or most recent)

EDUCATION

HIGH SCHOOL

NAME:

ADDRESS: LAST YEAR ATTENDED:

DIPLOMA RECEIVED: Yes No

COLLEGE

NAME:

ADDRESS: LAST YEAR ATTENDED:

DIPLOMA RECEIVED: Yes No

Other Education (vocational school, masters program, continueing education, etc.)

NAME:

ADDRESS: LAST YEAR ATTENDED:

DIPLOMA RECEIVED: Yes No

Please specify any any days or hours  you can't work?

REFERENCES:  Give two references, not relatives or former employers

 1. Name:

     Phone Number: 

 2. Name:

     Phone Number:

 You Must Read VERIFICATION STATEMENT  Below Before You Submit Your Application 

I Certify that the foregoing statements are true and correct to the best of my knowledge and belief and hereby grant the Company permission to verify such answers. I understand that any false statement on this application or at anytime during the selection process including interviews, tests, etc., may be considered as sufficient cause for rejection of my application or for dismissal if such false statement is discovered subsequent to my employment. O and/or the Fair Credit Reporting Act, and I understand that such a report may include information as to my character general reputation, personal characteristics, criminal history, financial condition and mode of living. I understand that, if any inquiry is made, the nature and scope of the information will be supplied to me upon written request. If I am employed, I agree to abide by and comply with all rules of the Company. I further understand and agree that, if I am employed, my employment is for no definite period and may be terminated at any time by either me or the Company. Additionally, I understand that this application will be considered in reference to the position(s) for which I applied at the time to completion of this form and that it will remain active for two weeks from receipt.

Have You Read Verification Statement:  Yes No