EMPLOYMENT APPLICATION
Excelsior Defense
United states of America
state of Florida Locations
(877)955-4636

PRE-EMPLOYMENT QUESTIONNAIRE
EQUAL OPPORTUNITY EMPLOYER

Background Investigation Waiver

I understand that as a condition of my employment for Excelsior Defense, I must submit to a complete background investigation as required by law. I fully understand that a satisfactory outcome to this investigation is a condition of employment and realize that my failure to assist and cooperate with the investigation will result in my loss of employment.
DATE   
SSN:   
EMAIL:
 
Last Name:
 First
 Middle
    
Present Street Address: City:
 State:
 Zip Code:
  
Phone Number:
 D.O.B.:
      
PREVIOUS ADDRESSES FOR THE PAST 5 YEARS
1. Street:
 City:
 State:
 Zip Code:
 How Long:
  
2. Street:
 City:
 State:
 Zip Code:
 How Long:
  
3. Street:
 City:
 State:
 Zip Code:
 How Long:
  
4. Street:
 City:
 State:
 Zip Code:
 How Long:
  
EMPLOYMENT DESIRED
Position: Full Time: Part Time: Can Start Date:
 Salary:
  
Are You Employed Now? If so may we contact your employer?

EDUCATION
  Name and Location of School:
 Years Attended Did you graduate? Subjects Studied
High School:
College:
Trade:
FORMER EMPLOYERS (List below last four employers, starting with the last first)                           
Name & Address of Employer Date: FROM/TO Phone # Position Reason for Leaving Salary
REFERENCES (Names of three persons not related to you, whom you have known at least one year.)
Name:
1. 		Address:
 Phone:
 Years Aquainted
2.
3.
U.S. MILITARY, LAW ENFORCEMENT
Military or Law Enforcement
 Branch or City:
AVAILABILITY
Are you available to work any days and hours?

If No please explain:

Are you available for outdoor assignments?
 Do you have trasportation?
 How far are you willing to travel?
RECORD OF MOTOR VEHICLE AND CRIMINAL CONVICTIONS
Driver License # state Issued:

1. 		   
2.    
3.    
4.    
Convictions   
ALCOHOL AND DRUGS
How often do you drink? Do you take drugs?  
LICENSE INFORMATION
Class "D" License Number: Exp. Date:
  
Class "G" License Number: Exp. Date:
  
Weight: Height: Eye Color: Hair: Gender:
Referred By:    
IN CASE OF EMERGENCY NOTIFY
Name:
 Address:
 Phone #:

STATEMENT OF CONFIDENTIALITY & RESPONSIBILITY

I, the undersigned, holding a position with Excelsior Defense, acknowledge the great importance of privacy of any customer(s) of Excelsior Defense, on whose site my employment causes me to be located. As a condition of my continued employment, I accept the responsibility of maintaining the strictest confidence, any information in regard to procedures, policies, practices, equipment and capabilities, or any other information that, due to my employment with Excelsior Defense, I am exposed to or made aware of.

DATE: SIGNATURE:

"I certify that the facts contained in this application are true and complete to the best of my knowledge and understand that, if employed, falsified statements on this application shall be grounds for dismissal, I authorize investigation of all statements contained herein and the references listed above to give you any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise, and release all parties from all liability for any damage that may result from furnishing same to you. I understand and agree that, if hired, my employment is for no definate period and may, regardless of the date of payment of my wages and salary, be terminated at any time without any prior notice."

DATE: SIGNATURE:

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Officer conducting application review:

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