EmailMe Form - Membership Application

Position Applied For *

Name *

First MI Last Suffix

Address *

Street Address City State / Province / Region Postal / Zip Code Country / Region

Personal Information

Date of Birth *

MM / DD / YYYY

Social Security Number *

No Dashes

Cell Phone Number *

### - ### - ####

Other Phone Number

### - ### - ####

Applicant's Email *

Please confirm

CRIMINAL / BACKGROUND:

Have you ever been ARRESTED or DETAINED by Law Enforcement? *

Yes

No

If (YES) please explain

Please explain any Criminal charges including Traffic Tickets

If Charge(s) are dismissed please provide court paperwork.

Take picture of Court Documents

Have you ever been or are you now employed with CSI? *

Yes

No

Do you have any relatives working for CSI? *

Yes

No

If (YES) please explain

List names of relatives working with C.S.i.

*Do you have an ANDROID CELL PHONE? *

Yes

No

Do you have transportation? *

Yes

No

If (YES) please explain *

Please list Make, Model Year and Tag Number

Can you submit legal verification of your right to work in the United States?
(In accordance with the Immigration Reform and Control Act of 1986, proof of authorization to be employed in the United States will be required of all prospective employees. Failure to establish such proof will prohibit or discontinue employment.) *

Yes

No

Are you over the age of 18? *

Yes

No

Questions and Answers:

I do agree, it’s my responsibility to check my emails and keep up with daily (STATS for Pay Incentive). *

Yes

No

I do agree, it’s my responsibility to update my address and contact information. *

Yes

No

I do agree, it’s my responsibility to take care of all issued company equipment and return it in good condition. *

Yes

No

I do agree, it’s my responsibility to keep a working cell phone and to ensure that CSI has the correct number and to keep all GPS tracking active while on duty. *

Yes

No

I do agree, it’s my responsibility to turn in or upload all daily paperwork at the end of shift, including time sheets and reports. *

Yes

No

POSITION/AVAILABILITY:

Must be available

Is this acceptable for you? *

YES

NO

If (NO) please explain below.

HOW DID YOU HEAR ABOUT THIS POSITION? *

What date are you available to start work? *

MM / DD / YYYY

EDUCATION:

Did you graduate from High School or Do you have a G.E.D.? *

Yes

No

Upload High School Diploma

Take one picture of High School Diploma

Name and Address Of School - Degree/Diploma - Graduation Date *

Skills and Qualifications: Licenses, Skills, Training, Awards *

IN 25 WORDS OR MORE, EXPLAIN WHY YOU WANT TO BE A SECURITY OFFICER? *

CSI has mostly nighttime schedules, which include working weekends and Holidays. Is this acceptable to you? If so, what hours do you prefer?

Answer Yes or No *

Security Officer Duties require walking for long periods of time. Will this be a problem for you? if yes explain.

Answer Yes or No *

CSI requires that all accepted members pass an entrance examination, which is given, at the end of our three-day orientation before being assigned to any post. If you are accepted there will be no charge to attend the training session. Is this acceptable to you?

Answer Yes or No *

Do you understand that a Security Officer even if ARMED is NOT a Police Officer?

Answer Yes or No *

It will be your responsibility to get to your scheduled assignment on your own and it is not the responsibility of CSI Do you understand and accept this?

Answer Yes or No *

I Understand: It’s my responsibility to check email daily.

Answer Yes or No *

I Understand: It’s my responsibility to update address.

Answer Yes or No *

I Understand: It’s my responsibility to take care of all issued equipment.

Answer Yes or No *

I Understand: It’s my responsibility to keep a working Phone and CSI has the correct number.

Answer Yes or No *

I Understand: It’s my responsibility to turn in all daily Paperwork, including time and reports.

Answer Yes or No *

EMPLOYMENT HISTORY:

Present Or Last Position:

(1) Employer: *

Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Supervisor: *

Phone Number *

### - ### - ####

Position Title: *

Start Date *

MM / DD / YYYY

End Date *

MM / DD / YYYY

Responsibilities: *

Salary *

Input hourly wage, if not salaried.

Reason for Leaving: *

Previous Position

(2) Employer: *

Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Supervisor: *

Phone Number *

### - ### - ####

Email

Position Title: *

Start Date *

MM / DD / YYYY

End Date *

MM / DD / YYYY

Responsibilities: *

Salary *

Input hourly wage, if not salaried.

Reason for Leaving: *

May We Contact Your Present Employer? *

Yes

No

Have you ever served in the MILITARY SERVICE? If so what branch. *

Discharge Status *

References 1:
Name/Title Address Phone *

References 2:
Name/Title Address Phone *

References 3:
Name/Title Address Phone *

Upload Documents

Upload Your Picture *

Take one picture of self and upload.

Upload Your Drivers License or ID Card *

Take one picture of Drivers License or ID Card

Upload Your Social Security Card *

Take one picture of Social Security Card

Upload Your Police Background Check *

Take one picture of police background check from any local police department.

Document Upload

**READ: Upload any Documents or Certificates that you have obtained. You may upload Drivers Licenses, Criminal History Check (within 30 days) and any other documents you think that may qualify you for membership.

Applicant Agreement

I certify that the information given in this application is true and complete to the best of my knowledge.

I understand that this application is not a contract of employment. I further understand that either City Security or Security Staffing, LLC.may terminate membership with or without cause my Membership and compensation at any time. I understand that I must give advanced notice before resigning.I understand that submission of the application in no way assures me a position and that no City Security representative has the authority to enter into any Membership agreement with me contrary to the foregoing.

Membership with City Security is contingent upon successfully passing a three day non paid orientation before being hired, a medical and physical examination (which will include a drug screening provided at no cost to the applicant).

I understand that failure to submit a complete application may disqualify me from consideration for a position.

I understand that any untrue statement in the application may result in my dismissal at any time during my Membership with City Security.

I understand and agree that I will follow all policy and procedures of City Security. I understand and agree that City Security uses a mobile application for report writing and guard control. I understand that I will not hold City Security responsible for any damages via a third party application or software. I further understand that I will not be compensated for the use of my cellular telephone. However, I agree that while employed at City Security I will maintain working service with my telephone provider and while on duty that I will keep my GPS tracking device on at all times.

I authorize the release of high school and college transcripts, information concerning my previous employment and any information my former employers may have pertinent to the application and the Membership procedures of City Security. I release all parties from all liability for any damage that may result from requesting, providing, processing, retaining or releasing any information about me. A photographic copy of this authorization shall be as valid as the original.

I understand resumes, letters of reference, certificates, etc., submitted with the application become the property of City Security and cannot be returned. The information I have provided on the application is subject to public disclosure under the Open Records Act.

I authorize, and give my consent for City Security to take my picture or video during the course of Membership. I understand and agree that these photos or video may include images of me performing my duties.

I understand that I have no rights to these photos or video, and they shall be used exclusively for company business. I further understand and acknowledge that there will be no compensation for these photos.

I understand that disclosure of my Social Security number on this application for Membership is voluntary, That this information is solicited pursuant to policies, and that it is intended to be used for the purposes of identification and tracking for Membership transactions.

PRE-MEMBERSHIP DRUG TESTING ACKNOWLEDGEMENT
I hereby acknowledge and understand that, as part of my application for membership for a position, which involves the performance of safety-sensitive functions I must submit to a urine drug test. I acknowledge and understand that any offer of membership is contingent on the passing of the aforementioned drug test and I will not be assigned to perform a safety-sensitive function unless my urine drug test has a verified negative result having no evidence of prohibited drug use.

By signing this application, I hereby acknowledge that I understand and agree to all provisions outlined herein.

EMPLOYEE NON-DISCLOSURE AGREEMENT

FOR GOOD CONSIDERATION, and in consideration of being employed by City Security, the undersigned employee hereby agrees and acknowledges:

1. That during the course of my employ there may be disclosed to me certain trade secrets of the Company; said trade secrets consisting but not necessarily limited to:

(a) Technical information: Methods, processes, formulae, compositions, systems, techniques, inventions, machines, computer programs and research projects.

(b) Business information: Customer lists, pricing data, sources of supply, financial data and marketing, production, or merchandising systems or plans.

2. I agree that I shall not during, or at any time after the resigning or termination of my employment with the Company, use for myself or others, or disclose or divulge to others including future employees, any trade secrets, confidential information, or any other proprietary data of the Company in violation of this agreement.

3.I agree that I shall not during, or at any time after resigning or termination of my employment shall I cause directly or indirectly slander, gossip or defaming of the company. Furthermore I aggress not to return to any of said
companies guarded property or communicate with any current employee of said company.

4. That upon resigning or termination of my employment from the Company:

(a) I shall return to the Company all documents and property of the Company, including but not necessarily limited to: drawings, blueprints, reports, manuals, correspondence, customer lists, computer programs, and all other materials and all copies thereof relating in any way to the Company's business, or in any way obtained by me during the course of employ. I further agree that I shall not retain copies, notes or abstracts of the foregoing.

(b) The Company may notify any future or prospective employer or third party of the existence of this agreement, and shall be entitled to full injunctive relief for any breach.

(c) This agreement shall be binding upon me and my personal representatives and successors in interest, and shall inure to the benefit of the Company, its successors and assigns.

As a term of employment, all whom, want to resign from CSI Workforce, Inc. are required to issue a 14-day written notice to our corporate office, in person. All employees who fail to issue this notice or are terminated for a No-Call/No-Show or Post Abandonment will be subject to pay decrease to minimum wage, for the entire pay period yet to be paid.

In the case of Sleeping and / or Abandonment of Post you will NOT be paid for the shift. Leaving without a relief is considered post abandonment.

City Security or Security Staffing, LLC does not discriminate on the basis of race, color, national origin, sex, religion, age or disability in Membership or the provision of services.

Do you agree with the terms and conditions? *

Yes, I agree.

Signature *

Clear

Date *

MM / DD / YYYY

Name *

First Middle Last Suffix

I agree that my affixed typed name shall serve as my original signature.

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