Applying For Guardus,Inc. SECTION ONE: PERSONAL INFORMATION Employees of Virginia Metro Protective Services and applicants for employment shall be afforded equal opportunity in all aspects of employment without regard to race, color, religion, political affiliation, national origin, disability, gender, or age. 1. Position Applying For: Security Guard Patrol Officer 2. Availability Monday Tuesday Wednesday Thursday Friday Saturday Sunday 3. Times Available Earliest time I can start my shift:* : HH MM Latest time my shift can end:* : HH MM 4. Available to start on: Month123456789101112 Day12345678910111213141516171819202122232425262728293031 Year202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920 5. Name* First Name Last Name 6. Date of Birth: Month123456789101112 Day12345678910111213141516171819202122232425262728293031 Year202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920 Home #: Work #: Mobile #: Email Current Address (Include street, city, state, and zip code): How long at present address? 7. Do you have a valid drivers license? Yes No 8. Do you have your own transportation? Yes No 9. Have you been convicted of a crime in the past, excluding summary traffic offenses, which has not been annulled, expunged, or sealed by a court? Yes No If Yes, please explain in full: Date of conviction: Month123456789101112 Day12345678910111213141516171819202122232425262728293031 Year202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920 10. For the purpose of compliance with the United States Immigration and Nationalization Act, and Section 40.1-11.1 of the Code of Virginia, are you legally eligible for employment in the United States? Yes No SECTION TWO: PERSONAL HISTORY 1. Have you ever used any illegal drugs or substances, such as Marijuana, Heroin, LSD, Speed, Acid, Crack, or Cocaine? Yes No If Yes, please explain in full: 2. How many alcoholic beverages do you consume weekly? If Yes, what for: 3. Are you currently on any type of medication? Yes No If Yes, what for: 4. Have you or are you currently serving in any branch of the Armed Services? Yes No If Yes, which branch: 5. High School Highest grade completed: Do you have a diploma or G.E.D? Yes No 6. College and/or Vocational School School(s): Highest grade completed: Diploma: Yes No Degree: 7. Security/Law Enforcement Academies School(s): City: State: Zip Code: 8. Are you currently certified? Yes No State of Virginia DCJS Certified Unarmed Yes No Is Certification Current? Yes No State of Virginia DCJS Armed Certified Yes No Is certification Current? Yes No Other Certifications Yes No Certificate name 9. Why do you think you would be a good fit for Guardus Security? SECTION THREE: WORKING HISTORY Working History* Company Name Role title Period Role description CERTIFICATION I hereby certify that all entries are true and complete, and I agree and understand that any falsification of information herein, regardless of time of discovery, may cause forfeiture on my part to any employment in the service of Guardus Security Services. I understand that all information on this questionnaire is subject to verification. I further authorize Guardus Security Services to rely upon and use, as it sees fit, any information received from such contacts. Information contained on this application may be disseminated to other agencies, nongovernmental organizations or systems on a need-to-know basis for good cause shown as determined by the agency head or designee. Comments This field is for validation purposes and should be left unchanged.