Step 1 of 5 20% Date of Application MM slash DD slash YYYY Position Applied For* Name* First Last Phone*Email* Address Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Are You 18 years of age or older? Yes No Are You a United States Citizen or Authorized to Work in the U.S? Yes No How were you referred to Starpoint Protective Services? Newspaper Internet Employment Agency Staffing Agency Walk-in Contacted by Starpoint Employee Referral Please Indicate Name of Employee Have you ever been employed by Starpoint Protective in the past? Yes No If so, when? Have you ever applied for employment by Starpoint Protective in the past? Yes No If so, when? Do you have any relatives employed by Starpoint? Yes No If yes, indicate name(s) Work AvailabilityWhen are you available to work? Monday Tuesday Wednesday Thursday Friday Saturday Sunday Type of work desired Full Time Part Time Temporary Overtime Date you can start MM slash DD slash YYYY Desired salary Are you currently on layoff status or subject to recall? Yes No Can you travel if a job requires it? Yes No Will you consider relocating? Yes No If yes, please indicate location Criminal Background / Drug Test / Exclusion CheckHave you ever been convicted of a criminal offense including a felony or misdemeanor?* No Yes A conviction includes a plea, verdict, or finding of guilt, regardless of whether sentence is imposed by the court and a criminal offense including a crime, felony, misdemeanor or disorderly persons offense, or any other offense within Federal, State or Local criminal/penal lawsIf yes, please explain:Are you willing to submit to a background screening?* Yes No Are you willing to submit to a pre-employment-offer drug screening?* Yes No Are you currently or have you ever been excluded, disbarred, suspended or otherwise declared ineligible to participate in any Federal or State health care plan (Medicaire and Medicaid) and/or any Federal or State procurement program?* Yes No If yes, please explain:Are you currently or have you ever been excluded, disbarred, suspended or otherwise declared ineligible to participate in any Federal or State health care plan (Medicaire and Medicaid) and/or any Federal or State procurement program?* No Yes If yes, please explain:Are you aware of any proceedings or investigations that are currently pending or threatened by any Federal or State agency seeking to have you excluded, disbarred, suspended or otherwise to sanction you for any violation of any State or Federal rule or regulation?* No Yes If yes, please explain:Please note: the existence of a criminal record will not necessarily prevent employment Driving RecordDo you possess a valid Driver's License?* Yes No Driver's License Number State Issued Are there any current restrictions on your Driver's License?* Yes No Please Indicate Restrictions Below Have you been found guilty of a moving violation or had your license suspended in the past 7 years?* No Yes If yes, when? Military ServiceHave you served as a member of the Armed Forces of the United States or any other country?* Yes No Branch of Service If not US Armed Forces, indicate country. Dates of ServiceFrom MM slash DD slash YYYY To MM slash DD slash YYYY Currently a member of the National Guard/Reserves* Yes No Rank at time of discharge/separation Job classification Educational HistoryHigh SchoolName and Address of SchoolDid you graduate? Yes No Course of Study High School Diploma G.E.D. State Issued Date College or UniversityName and Address of SchoolDid you graduate? Yes No Course of Study Diploma Other Schooling, Vocational, or TrainingName and Address of SchoolDid you graduate? Yes No Course of Study Diploma/Certification Professional License / Certification / RegistrationDo you have any current professional licenses, certificates, or registrations?* Yes No Please indicate current professional licenses, certificates or registrationsAre there any restrictions on your professional license?* Yes No Please explain:Specialized training, skills, memberships, associationsDescribe below any specialized work-related training, internships, apprenticeships, skills, or work-related activities Employment HistoryPlease account for all your time during the past ten (10) years, including full-time, part-time, temporary positions, volunteer work, schooling, unemployment, self-employment, military service, and so forth.Employer Name Employment Start Date MM slash DD slash YYYY Employment End Date MM slash DD slash YYYY Employer Address Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Employer Phone NumberSupervisor Name First Last Supervisor Title Your Job Title Final Salary Reason for Leaving Your job duties and responsibilitiesEmployer Name Employment Start Date MM slash DD slash YYYY Employment End Date MM slash DD slash YYYY Employer Address Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Employer Phone NumberSupervisor Name First Last Supervisor Title Your Job Title Final Salary Reason for Leaving Your job duties and responsibilitiesEmployer Name Employment Start Date MM slash DD slash YYYY Employment End Date MM slash DD slash YYYY Employer Address Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Employer Phone NumberSupervisor Name First Last Supervisor Title Your Job Title Final Salary Reason for Leaving Your job duties and responsibilitiesEmployer Name Employment Start Date MM slash DD slash YYYY Employment End Date MM slash DD slash YYYY Employer Address Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Employer Phone NumberSupervisor Name First Last Supervisor Title Your Job Title Final Salary Reason for Leaving Your job duties and responsibilitiesNote: You may choose to upload a resume, but you must still complete all of the information in the previous section.Upload your resumeAccepted file types: pdf, doc, docx, Max. file size: 256 MB.Files accepted: pdf, doc, docx Professional ReferencesPlease provide the names of at least three (3) persons (not relatives) who may be contacted to provide professional references.Name* First Last Occupation PhoneEmail How does this person know you? How long have they known you? Name* First Last Occupation PhoneEmail How does this person know you? How long have they known you? Name* First Last Occupation PhoneEmail How does this person know you? How long have they known you? Application Acknowledgement and AuthorizationI hereby certify that all of the information provided by me in this application, which includes any additional required documents or materials, is correct, accurate and complete to the best of my knowledge. I understand that the falsification, misrepresentation or omission of any facts in said information or documentation will be cause for denial of employment or grounds for immediate termination of employment. Further, I understand that this statement holds true regardless of the timing or circumstances of discovery. I understand that submission of an application does not guarantee employment. If employed, I agree to conform to the rules, regulations, policies and procedures of Starpoint Protective Services, LLC at all times. I understand that if offered a position, I will be required to submit a pre-employment drug screening and background check as a condition of employment. I also understand that unsatisfactory results from, refusal to submit, or any attempt to affect the results of these tests and checks will result in withdrawal of any employment offer. I hereby authorize any and all government agencies, companies, other agencies, or any others who have information about me to provide such information to Starpoint Protective Services, LLC and/or any of its representatives, agents or vendors. I release parties involved from any and all liability for any and all damage that may result from providing such information. By submitting my name below, I acknowledge that I have read, understood and agree to the above statements.Your Name First Last Today's Date MM slash DD slash YYYY Email