Miller Protective Services | Employment

EMPLOYMENT HISTORY

MILLER PROTECTIVE SERVICES

44 Broad Street, Suite 802 - Atlanta, Georgia, 30303

Phone: 404-222-0055 - Email: mp_services@bellsouth.net

www.millerprotectiveservices.com

__________________________________________________________________________________________________________________________________

APPLICANT INFORMATION

Last Name: *

Last Name: *

M.I *

Date of Birth: * +

Street Address: *

Apartment Unit#:

City: *

State: *

Zip: *

Home Phone:

Cell Phone: *

Email Address:

Date Available: * +

Social Security #: *

Driver License #:

State Issued:

Full Time:

Part Time:

Day Shift:

Night Shift:

Are you a citizen of the United States? *

YES

NO

If no, are you authorized to work in the U.S? *

YES

NO

Have you ever been convicted of felony? *

YES

NO

If yes, explain:

Have you ever worked for a security company? *

YES

NO

If so, what Company & when?

EDUCATION

High School: *

Address: *

From: * +

To: * +

Did you graduate? *

Yes

No

Degree

College: *

Address: *

From: * +

To: * +

Did you graduate? *

Yes

No

Degree

REFERENCES

Please list three professional references

Full Name: *

Relationship *

Address: *

Company: *

Phone Number: *

Full Name: *

Relationship *

Company: *

Phone Number: *

Address: *

Full Name: *

Relationship *

Company: *

Phone Number: *

Address: *

PREVIOUS EMPLOYMENT

Company: *

Phone Number: *

Address: *

Supervisor: *

Job Title: *

Starting Salary: *

Ending Salary: *

Responsibilities *

From: * +

To: * +

Reason for leaving: *

May we contact your previous supervisor for a reference? *

Yes

No

Company:

Phone Number:

Address:

Supervisor:

Job Title:

Starting Salary:

Ending Salary:

From: +

To: +

Reason for leaving:

May we contact your previous supervisor for a reference? *

Yes

No

Company:

Phone Number:

Address:

Supervisor:

Job Title:

Starting Salary:

Ending Salary:

From: +

To: +

Reason for leaving:

May we contact your previous supervisor for a reference? *

Yes

No

Company:

Phone Number:

Address:

Supervisor:

Job Title:

Starting Salary:

Ending Salary:

From: +

To: +

Reason for leaving:

MILITARY SERVICE

Branch:

From: +

To: +

Rank at Discharge:

Type of Discharge:

If other than honorable, explain:

DISCLAIMER & SIGNATURE

I certify that my answers are true and complete to the best of my knowledge. I authorize Samja Consulting, dba MILLER PROTECTIVE SERVICES to make such investigations and inquiries of my personal employment, educational, financial and other related matters as may be necessary for an employment decision. I hereby release employers, schools or individuals from all liability when responding to inquiries in connection with my application.

In the event I am employed, I understand that false or misleading information in my application or interview(s) may result in discharge.

Signature of Applicant *

clear

Date: * +