Online Application

Full Name (required):

Contact Email (required):

DOB (Month, Day, Year):

Place of Birth:

HGT:

WGT:

Home Address (Street, City, State, Zip):

Cell Phone Number:

Home Phone Number:

Veteran's Preference:

For consideration a DD214/215 MUST be furnished

Date of Entry:

Date of Discharge:

Branch of Service:

Area of Conflict:

Honorable Discharge?

Right to Work / Citizenship:

The Immigration Reform and Control Act of 1986 requires that all employees verify proof of legal right to work in the U.S. A U.S. Passport or combinations of government-issued picture identification and a birth certificate, social security card or Alien Registration card are examples of proof. If hired, can you provide proof as required?

US Citizen:

Alien Registration Card?

Registration Card Number:

Date of Entry:

Point of Entry:

Position Applied For:

Certifications
Unarmed:

Permit Number:

Expiration:

Armed:

Permit Number:

Expiration:

Shotgun (TN):

Expiration:

Issuer:

Chemical Agent:

Expiration:

Issuer:

ASP Baton:

Expiration:

Issuer:

Taser:

Expiration:

Issuer:

First Aid:

Expiration:

Issuer:

CPR:

Expiration:

Issuer:

Additional - pertinent to position applied for
Please include description, Permit #, State, and Expiration

Work History
Note to Applicant: Black Lion Security requires an account of your past ten (10) years of employment, beginning with most recent. If there are any gaps, please explain. Previous employment will be taken into consideration as a basis of your qualifications for the position applied for. If needed, continue on a separate sheet of paper.

Employer Name:

Supervisor Name:

Position:

From:
to:

Rate of Pay:

Contact Number:

Duties:

Employer Name:

Supervisor Name:

Position:

From:
to:

Rate of Pay:

Contact Number:

Duties:

Employer Name:

Supervisor Name:

Position:

From:
to:

Rate of Pay:

Contact Number:

Duties:

General Work Inquiries:
1. Have you ever had a professional license suspended or revoked?

2. Have you ever been asked to resign from a position or terminated?

3. Have you ever been the subject of a job related investigation involving theft, harassment, or violence?

Education
Note to Applicant: For consideration for employment, applicant must provide documented proof of completion of high school in the form of either diploma or GED certificate.

Name of School:

Address

Area of Study:

Semester Hours:

Degree / Diploma:

Name of School:

Address

Area of Study:

Semester Hours:

Degree / Diploma:

Name of School:

Address

Area of Study:

Semester Hours:

Degree / Diploma

References
Provide (3) professional references NOT to include supervisors from above

Name:

Contact Number:

Address

How long known?

Name:

Contact Number:

Address

How long known?

Name:

Contact Number:

Address

How long known?

Driving History
Within the past five (5) years, do you have any moving violations?

If yes, how many?

Has your drivers license ever been suspended or revoked?

Have you ever been arrested and/or convicted of DWI/DUI?

Criminal History:
Note to Applicant: While certain criminal offenses and/or the subsequent conviction might not bar you from employment, a formal record of disposition from the presiding court will be required before any further consideration is made.

Have you ever been arrested for a criminal offense?

Have you ever been arrested for crime involving theft or dishonesty?

Have you ever been arrested for crime involving assault?

Have you ever been arrested for a crime involving domestic violence?

If answered yes to any previous question, were you convicted?

General Background
Residency for Past Five (5) Years (please include street address, city, state, zip, from date and to date.)

Personal Weapon(s) Record (please include make, model, caliber, serial number, and barrel length):