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Employee Statement & Security Guard Application

In accordance with applicable law, this company is an equal opportunity employer and does not discriminate because of race, religion, color, age, gender, national origin, marital status, disability, genetic information, veteran status, sexual orientation, or any other status protected by law. No question on this application is intended to secure information to be used for such discrimination

Applicant's Statement of Understanding and Authorization

I understand that this application will be given every consideration, but its receipt does not imply that the applicant will be employed. I understand that I may choose to leave any portion of the application incomplete or blank and that the following information is given voluntarily. I understand and authorize the company to obtain a consumer report of my financial and credit record as well as an investigative consumer report whereby information is obtained through personal interviews with neighbors, friends and others to whom I am acquainted with. This investigation includes information about my character, general reputation, personal characteristics and mode of living. I understand that I have the right to make a report. I give my permission to Servant Anchor Security Services to contact any of my former employers to release all records of my employment including assessments of my job performance, ability and fitness. understand that the company may require a motor vehicle record (MVR) report. I understand that Servant Anchor Security Services reserves the right to require a medical examination as well as periodic physical and medical examinations and pre-employment as well as post­employment drug and alcohol testing, to the extent permitted by law. I hereby state that the dismissed from Servant Anchor Security Services. If I am employed, I understand that such employment is at will and will not result in an employment contract for any specific term unless otherwise specified.

APPLICANT INFORMATION

MM slash DD slash YYYY
Place of Birth(Required)
Name(Required)
Ethnicity(Required)
Address(Required)
Mailing Address (P.O. Box may be added to ensure delivery)
Type of Employment(Required)
Are you currently employed?(Required)
Have you ever worked for this company before?(Required)
Are you able to meet attendance requirements for this job?(Required)
Do you have means of transportation to get to and from work?(Required)

Employment

Company Address(Required)
Employment Status(Required)
Company Address (2)
Employment Status (2)

Education

Diploma?(Required)
Degree?

Reference

Name(Required)
Name (2nd Reference)

General Information

Background Questionnaire

1. Are you a citizen of the United States or a legal resident of the United States in possession of a valid alien registration card?(Required)
2. Are you a peace officer? If yes, and if you qualify for an exemption, you must submit further documentation. If you do not qualify, you must submit training certificates.(Required)
Are you a peace officer? If yes, and if you qualify for an exemption, you must submit further documentation. If you do not qualify, you must submit training certifications.(Required)
4. Have you ever been convicted in this state or elsewhere of a crime or offense that is a misdemeanor or a felony?(Required)
Max. file size: 256 MB.
5. Are there any cl'iminal charges (misdemeanors or felonies) pending against you in any court in this state or elsewhere?(Required)
Max. file size: 256 MB.
6. Has any license or permit issued to you or a company in which you are or were a principal in Texas State or elsewhere ever been revoked, suspended or denied'?(Required)
7. Have you ever been discharged from a correctional or law enforcement agency for incompetence or misconduct as determined by a court of competent jurisdiction, administrative hearing officer, administrative law judge, arbiter, arbitration panel or otber duly constituted tribunal, or resigned from such an agency while charged with misconduct or incompetence'?(Required)
8. Have you ever been declared to be incompetent by reason of mental disease or defect, which bas not been removed by any court of competent jurisdiction?(Required)
9. Have you ever applied in this state or elsewhere for a registration/license as a security guard; watcb, guard or patrol agency; private investigator'?(Required)
10. Have you ever served in one of the US Military components, including Reserves, National Guard, or Air National Guard?(Required)
11. Are you still currently serving as a military member?(Required)
Max. file size: 256 MB.

SERVANT ANCHOR SECURITY SERVICES, LLC | License No.C9388601 | 12299 St Patrick's Forney Tx 75126 (214)326.8835

DRUG AND/OR ALCOHOL TESTING CONSENT FORM EMPLOYEE AGREEMENT AND CONSENT TO DRlJG AND/OR ALCOHOL TESTING

I hereby agree, upon a request macle unde1 the drug/alcol10l testing policy of Servant Anchor Secu1ity S,'.rvices, to submit to a drug or alcohol test and to furnish a sample ofmy urine, brc-ath, and/or blood for analysis. I understand and agree that irI at any time refuse to submit to a drug or alcohol test under company policy, or if I otherwise fail to cooperate with the testing, procedures, I wi 11 be subject to immediate tenninatio11. I further authorize and give lull permission to have Servant Anchor Security Services, LLC and/or its company physician send the specimen or specimens so collected to a laboratory for a screening test for the presence of any prohibited substances under the policy, and for 1he l:iborntory or other testing facility to release any and all documentation relating to such test to the Company and/or to any governtnental entity involved in a legal proceeding or investigation connected with the test. Finally, I authorize the Servant Anchor Security Services to disclose any documentation relating 10 such test to any governmental entity involved in a legal proceeding or investigation connected with the test. I also au1horize Servant Anchor Security Services to field test my specimen. If evidence is found, futiher testing may he required. I understand that only duly-authorized Company officers, employees, and agents will \,ave access to information furnished or obtained in connection with the test; that they will maintain and protect 111e confidentiality of such information to the greates1 ex1ent possible; and that they will share such information only to the extent necessary to make employment decisions and to respond to inquiries or notices from government entities. I will hold harmless the Company, its company physician, and any testing laboratory the Company might use, meaning that I will not sue or hold responsible such patiies for any alleged harm to me that might r result fom such testing, including loss of employment or any other kind of adverse job action that might arise as a result of the drug or alcohol test, even ifa Company or laboratory representative makes an error in the administration or analysis of'the test or the reporting of the results. l will finther hold harmless the Company, its company physician, and any testing laboratory the Company might use for any alleged harm r to me that might result fom the release or use of information or documentation relating to the drug or alcohol test, as long as the release or use of the information is within 1he scope of this policy and the procedures as explained in the paragraph above. This policy and authorization have been explained to me in a language I 11ndersia11d, and l have been told that if I have any questions about the test or the policy, they will be answered. I UNDERSTAND THAT THE COMPANY WILL REQUIRE A DRUG SCREEN AND/OR ALCOHOL TEST UNDER THIS POLICY WHENEVER l AM INVOLVED IN AN ON-THE-JOB ACCIDENT OR INJURY UNDER CIRCUMSTANCES THAT SUGGEST POSSIBLE INVOLVEMENT OR INFLUENCE OF DRUGS OR ALCOHOL IN THE ACCIDENT OR INJURY EVENT, AND 1 AGREE TO SUBMIT TO ANY SUCH TEST.
Name(Required)
Initial same as signature
MM slash DD slash YYYY

APPLICANT AFFIRMATION

I certify that the informalion I have given in this application is true and completed to the best of my knowledge and understand that falsification, omissions, or misrepresentations of this information is grounds for rejection of my employment application and if employed hy Servant Anchor Secmity Services or may he terminated immediately. I authorize the character references, previous employers and education institutions listed above to give you any information concerning my previous employment and any r pertinent information they may have, personal or otherwise, and all parties fom all liability, claims, or for and damage that may result from me. l also release Servant Anchor Security Services from any and all liability of whatever kind and nature, which, at any time, could result r fom obtaining and having an employment, based on such information. J agree to conform to the rules and regulations of the company. Purthermore, I understand that if an offer of employment is extended, it is conditioned upon completing the federal J-9 Form and providing documents establishing identity and work authorization. I understand that my employment can be terminated with or without cause and with or without notice, at any time, at the option of either the company or myself. I understand that only the owner, manager, or representative of the company has the authority to enter into any agreement contrary to the foregoing. I represent that 1 am able to meet the attendance requirements as required by the company. I understand that by maintaining a current commission, license and operable mobile phone may be necessary for continued employment. I have read and fully understood the applicant's affirmation of understanding and authorization (refer to page one of Employee Statement and Security Guard Application.)
Initial same as signature
MM slash DD slash YYYY