EmailMe Form - Jade Alarm Employment Application

Name *

First Middle Last

Todays Date *

MM / DD / YYYY

Email *

Main Phone *

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

Social Security Number *

Cell Phone

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

Current Address *

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

Position(s) Applied For: *

Earliest date available to begin employment: *

MM / DD / YYYY

Are you at least 18 years of age? *

Yes

No

Are you currently employed? *

Yes

No

Have you ever been employed at Jade Alarm before? *

Yes

No

If yes, give dates of employment:

Do you have any commitments to a current or former employer that might affect your employment at Jade Alarm? *

Yes

No

Have you previously applied for employment with Jade Alarm? *

Yes

No

May we contact your current employer? *

Yes

No

If, “no”, explain the reason why:

Are you prevented from lawfully becoming employed in the United States because of Visa or Immigration status? *

Yes

No

Are you in a lay-off or other leave status, subject to recall or reinstatement? *

Yes

No

Have you ever worked in any position involving security, security systems, alarm systems, or law enforcement? *

Yes

No

If, “yes”, please identify all such employment by name of company or organization, a description of the nature of services you
provided, the dates of employment and the specific reasons for termination of employment. If the reason for termination was due to
alleged misconduct or performance, provide specific detail of the events:

Have you ever applied for and been denied any security clearance by any company or organization, or, held a security clearance which was withdrawn or revoked? *

Yes

No

If, “yes”, please provide a detailed description:

Jade Alarm provides security systems operation to customers on a 24 hour basis, seven days per week. Reliability and availability are important considerations for many jobs. If you have any questions about the potential schedules for the job being applied for, please ask for any explanations prior to answering the following questions on work availability.

Are you available for work: *

Full-time (32-40 hours/week)

Part-time

Temporary

Are you available to work overtime hours (in excess of 40 hours per week)? *

Yes

No

Are you employed in another job that you intend to keep if hired at Jade Alarm? *

Yes

No

If “yes”, please identify the employer, the nature of the work and the work schedule involved:

Do you have reliable means of transportation to and from work? *

Yes

No

Are there particular hours or days of the week you cannot work? *

Yes

No

If, “yes”, define which hours or days are subject to limitations?

ANSWER THE FOLLOWING QUESTIONS ONLY AFTER YOU HAVE BEEN PROVIDED AN EXPLANATION OF THE JOB BEING APPLIED FOR OR PROVIDED A GENERAL JOB DESCRIPTION

Are you capable of performing in a reasonable manner, with or without a reasonable accommodation, the activities involved in the job for which you have applied?

Yes

No

If the job involves driving a vehicle for purposes of performing work duties:

Do you have a valid driver’s license?

Yes

No

Has your driver’s license been suspended or revoked in the past five (5) years?

Yes

No

If, “yes”, please explain why.

SPECIALIZED JOB SKILLS AND TRAINING:

Explain the details of specialized job skills and training you have either through job related experience or educational programs. (For example: computer, office equipment, mechanical repair, electronics, languages, telecommunications systems, security systems, accounting/bookkeeping, supervision, law enforcement, other skills)

OTHER QUALIFICATIONS:

Explain the details of employment or other experiences and training that would demonstrate job skills, learning capabilities, responsibility, communications skills, organizational skills, honors, special recognition, civic involvement or other qualifications:

Employment History

Name of Employer

Your Position:

Final Salary
($/hr,/wk,/yr)

Reason for Leaving

Contact Person

Contact #:

From: (mm/yy)

To: (mm/yy)

Employer's Address

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

Name of Employer

Your Position:

Final Salary
($/hr,/wk,/yr)

Reason for Leaving

Contact Person

Contact #:

From: (mm/yy)

To: (mm/yy)

Employer's Address

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

Name of Employer

Your Position:

Final Salary
($/hr,/wk,/yr)

Reason for Leaving

Contact Person

Contact #:

From: (mm/yy)

To: (mm/yy)

Employer's Address

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

Please explain any gaps in employment

Education

Education *

	Name of School	Address of School	Course of Study	Years Completed	Diploma/Degree
Elementary School
High School
Undergraduate College 1
Undergraduate College 2
Graduate/Professional
Other (Please Specify

References

References *

	Name	Phone	Work Phone	Address	Nature of Acquaintance
Reference 1
Reference 2
Reference 3

Applicant's Statement

1. I hereby affirm that the information provided on this application (and accompanying resume, if any) is true and complete to the
best of my knowledge. I also agree that falsified or misleading information or significant omissions may disqualify me from
further consideration for employment and may be considered justification for dismissal if discovered at a later date.

2. I authorize persons, schools, and current employer (if applicable) and previous employers and organizations named in the
application (and accompanying resume, if any) to provide any relevant information that may be required to arrive at an
employment decision, and release all parties from all liability for any damage that may result from furnishing same to you.

3. I understand that if a job offer is made, a medical examination may be requested for employment or continuation of
employment; and that I may be requested to submit to testing for drug or alcohol use both prior to hire or for continuation of
employment.

4. This application is not a contract for employment and cannot create a contract. I understand that if I am hired my employment
can be terminated with or without cause or reason, at any time at the discretion of either the company or myself.

5. I understand this application will be kept in the active files only for filling an open job for which I have applied. I further
understand that if I am not hired during that period, I must complete and execute a new application form to be considered for
employment.

Applicant Name *

Applicant Signature *

Clear

Date Time *

MM / DD / YYYY