NASS STRIKE SECURITY EMPLOYMENT APPLICATION

Please complete form, and a confirmation of acceptance or rejection will be returned to you. Thank you!

BACKGROUND:

Date:    
Last Name:    
First Name: 
Middle Initial: 
Address: 
City:    State:   Postal Code:
Home Telephone:    Secondary Phone:    
Cellular Phone:    
Email: 
Social Security #: 
Driver's License #:    Do you have a CDL?  Yes No   

U.S. Citizen?  Yes No  
Birthplace:  Country, City, and State: 
Nearest Airport:    Secondary Airport:    
Emergency Notification: Relationship and Phone Number: 

MILITARY: 

Branch of Military Service:  N/A Air Force Army Marines Navy   Date Entered:    Years Served: 
Primary Duties while in Service: 
Type of Discharge:    Rank at time of Discharge:   
Present Classification:   
Are you a member of the National Guard or Reserves?  N/A Yes No   
If so, what branch? 
Have you ever had disciplinary action while in the service?   N/A Yes No   
If so, give details: 

CRIMINAL RECORD: 
Have you ever been convicted of a Misdemeanor or Felony?  No Yes   
If so, give complete details: 

EDUCATION:

Name of High School:    
Complete Address: 
Major course(s) of study? 

Did you graduate?  N/A No Yes
Name of College    
Complete Address: 
Major course(s) of study? 

Did you graduate?  N/A No Yes  

PREVIOUS EMPLOYMENT:  (list previous employer(s) for last five years.  list most recent first)

1.  Name of Employer:    Your Position:   
Employment Dates:  (from-to)
Employer's Phone:    
Address:   
Immediate Supervisor: 
Primary Duties:   
Reason for Leaving: 

2.  Name of Employer:    Your Position:   
Employment Dates:  (from-to)
Employer's Phone:    
Address:   
Immediate: 
Primary Duties:    
Reason for Leaving: 

3.  Name of Employer:   
Your Title:   
Employment Dates:  (from-to)
Employer's Phone:    
Address:   
Immediate Supervisor: 
Primary Duties:    
Reason for Leaving: 

SPECIALTIES: 

Are you qualified in any of the following areas?  

1.  EMT

2.  Firefighter

3.  Audio Equipment

4.  Camera Equipment

5.  Video Equipment

6.  Other

List certificates and/or specialized training and the location of training received relative to any of the above: 

UNIFORM AND EQUIPMENT SHEET:

Height:    Weight:    Waist Size:   

Shirt Size:      Coat Size:    Inseam: 

Remarks/Comments: 

LIST ANY ADDITIONAL OR SPECIAL SKILLS YOU HAVE THAT WOULD HELP QUALIFY YOU FOR A POSITION WITH NASS CONDUCTING STRIKE SECURITY SERVICES.

I AFFIRM THAT THE INFORMATION ON THIS APPLICATION IS TRUE TO THE BEST OF MY KNOWLEDGE.  I ALSO UNDERSTAND THAT I WILL BE REQUIRED TO SUBMIT TO A DRUG TEST AT THE BEGINNING OF EACH ASSIGNMENT AND AT ANY TIME THE COMPANY DEEMS NECESSARY DURING AN ASSIGNMENT.  FAILURE OF THIS TEST OR REFUSAL TO SUBMIT TO A TEST WILL RESULT IN MY IMMEDIATE TERMINATION OF EMPLOYMENT FROM NASS.  I HEREBY AGREE DISAGREE

AUTHORIZATION TO RELEASE INFORMATION AND RECORDS: 

I hereby authorize the following organizations, individuals, and entities to provide NASS or its agents with any and all available information and copies of records/transcripts pertaining to me, my activities, and/or my status for the purpose of consideration for employment with NASS.

*     Present and past employers

*     Schools, colleges, universities, or other institutions of learning

*     Law enforcement agencies and custodians of court records

*     Custodians of state records

*     Branches of military service

*     Credit bureaus and financial reporting institutions

*     Individuals who serve as references

I hereby hold harmless from liability NASS and any other person(s) or agency and their employees and agents who may provide or discuss pertinent information on conjunction with the background investigation.  An electronic or machine copy of this authorization shall be considered as effective as the original.  I hereby AGREE DISAGREE