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Employment Application

Name:*

Job:

Location:

Date:

Equal Employment Opportunity/Affirmative Action Statement

NPI Security is an EEO/AA Employer. We will consider all applicants for positions without regard to race, creed, religion, color, sex, age, national origin, or disability. We comply with all applicable laws governing employment practices and do not discriminate based on any unlawful criteria.

Personal Data (please print)

Name (last, first, middle):*

Social Security Number:*

Address:*

City:*

State:*

Zip Code:*

Home phone:*

Work phone

If employed, can you provide proof of a legal right to work in the U. S.?*
Yes
No

Are you 18 or over?*
Yes
No

Position(s) applying for:

Referred by:

Have you ever been employed by NPI Security before?*
Yes
No

If yes, give details.

Education Record

High School:

Address:

Degrees or diplomas:

College/University:

Address:

Degrees or diplomas:

Trade or technical training:

Address:

Degrees or diplomas:

Military Service

Branch of Service:

Duties/special training:

Employment History

Begin with your most recent employer. Attach additional sheet if needed.

1. Employer:

Dates of employment:

Address:

City:

State:

Zip Code:

Phone:

Beginning salary:

Ending salary:

Title/duties

Supervisor’s name:

Reason for leaving:

2. Employer:

Dates of employment:

Address:

City:

State:

Zip Code:

Phone:

Beginning Salary:

Ending Salary:

Title/duties:

Supervisor's name:

Reason for leaving:

3. Employer:

Dates of employment:

Address:

City:

State:

Zip Code:

Phone:

Beginning Salary:

Ending Salary:

Title/duties:

Supervisor's name:

Reason for leaving:

REFERENCES

List three professional references that are familiar with the quality of your work, have worked directly with you, and have known you at least two years.

1. Reference:

Work phone:

Home Phone:

Address:

City:

State:

Zip Code:

Relationship:

2. Reference:

Work Phone:

Home Phone:

Address:

City:

State:

Zip Code:

Relationship:

3. Reference:

Work Phone:

Home Phone:

Address:

City:

State:

Zip Code:

Relationship:

PERSONAL DATA

Have you ever been convicted of a felony, aggravated misdemeanor or domestic abuse?*
Yes
No

If yes, give details.

This job requires a substantial amount of walking and setting for prolonged periods of time. Can you perform the requirements of this job with or without a reasonable accommodation?*
Yes
No

This job requires that you have a valid State of Iowa Drivers License. Do you have a license?*
Yes
No

Drivers License #:

Type:

Expiration Date:

This job requires that you have reliable transportation. Do you have reliable transportation?*
Yes
No

I understand that the accuracy and completion of my statements will be relied upon by NPI Security. I hereby authorize investigation of all statements contained in this application and permit NPI Security to obtain my transcripts, record or documents pertaining to my background and business experience. I agree to release NPI Security from any liability arising there from and pertaining to my background and business experience. I agree to release NPI Security from any liability arising there from and understand that any incorrect statements, omissions or false statements may be cause for dismissal or elimination from further consideration for employment.
I also understand that any offer of employment is not to be construed as an employment contract and only conditions that are agreed to in writing by an officer of the company are binding. I agree that my employment may be terminated at will, at any time by either NPI Security or myself.

Applicant's Signature:*

Date:*

Submit

* Required