CRIME PREVENTION OF FLORIDA LLC

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Employment Application

    Applicant Personal Information

    Last Name
    First Name
    Middle Name

    Address
    City
    State
    Zip

    Email

    Phone Number
    Date of Birth
    Place of Birth (city/state)

    Gender Race Eyes Hair
    Height Weight

    Marital Status:
    SingleMarriedDivorcedWidowed

    How many children do you have?
    Any other dependents?

    Are you a U.S. citizen?
    YesNo

    If not, what identification do you have?
    PASSPORT (include passport number)
    ALIEN REGISTRATION NUMBER (include registration)

    Applicant Identification and Licenses

    Social Security Number:

    Florida Driver’s License Number:
    Expires:

    Has your license ever been suspended?
    YesNo
    If affirmative, please explain:

    «D» Security License Number:
    Expires:

    «G» Security License Number:
    Expires:

    Concealed Weapon License Number:
    Expires:

    Have you ever obtained a firearm license in the state of Florida or any other state?
    YesNo
    Which State:

    List any other license or permit:

    Expires:

    Expires:

    Applicant Criminal History

    A) Have you ever been treated for a mental or nervous disorder?
    YesNo
    If affirmative, please explain:

    B) Have you ever received medical treatment for a drug habit?
    YesNo
    If affirmative, please explain:

    C) Have you ever been arrested for using marijuana, cocaine, or any hallucinogenic drugs?
    YesNo
    If affirmative, please explain:

    D) Have you ever been arrested for domestic violence?
    YesNo
    If affirmative, please explain:

    E) Have you ever been arrested?
    YesNo
    If affirmative, please explain:

    F) Have you ever been diagnosed with a mental illness?
    YesNo
    If affirmative, please explain:

    G) Are you currently using illegal drugs?
    YesNo

    H) Do you have a history of drug use?
    YesNo

    I) Do you have a history of alcoholism?
    YesNo

    J) Do you smoke cigarettes?
    YesNo

    Military History

    Have you ever served in a U.S. military organization?

    YesNo

    If affirmative, which branch?

    Serial Number:

    Type of Discharge:

    Have you ever served in a military organization of any foreign government?

    YesNo

    If affirmative, which country?

    Which branch?

    Type of Discharge:

    Skills and Training

    List any special skills or training that may help you in the position you are applying for.

    List ALL languages you speak:

    EnglishSpanishOther

    List ALL languages you write:

    EnglishSpanishOther

    Work History

    Dates of employment:

    From:

    To:

    Company name:

    Address:

    Phone:

    Last position held:

    Supervisor’s name:

    Reason for leaving:

    Salary information:

    Start:

    End:

    Dates of employment:

    From:

    To:

    Company name:

    Address:

    Phone:

    Last position held:

    Supervisor’s name:

    Reason for leaving:

    Salary information:

    Start:

    End:

    Dates of employment:

    From:

    To:

    Company name:

    Address:

    Phone:

    Last position held:

    Supervisor’s name:

    Reason for leaving:

    Salary information:

    Start:

    End:

    Educational Background

    Dates of attendance:

    Start date:

    End date:

    School name:

    Degree obtained:

    Dates of attendance:

    Start date:

    End date:

    School name:

    Degree obtained:

    Dates of attendance:

    Start date:

    End date:

    School name:

    Degree obtained:

    Addresses of the Last Five Years

    Write the full address of all the places you have lived in the last five years. Start with your most current address.

    Current address:

    City, State, Zip:

    From date:

    To date:

    Address:

    City, State, Zip:

    From date:

    To date:

    Address:

    City, State, Zip:

    From date:

    To date:

    Personal References

    List (2) people who have known you for three (3) years (other than relatives):

    Name:

    Address:

    Phone:

    Name:

    Address:

    Phone:

    Other Important Information

    Do you have transportation?

    YesNo

    How soon will you be available to work?

    What days and hours are you available?

    In case of an emergency, whom should we notify? Please include their name, relationship, and phone number.

    You are interested in:

    Full-timePart-timeTemporary

    What schedule would you prefer?

    WeekdaysWeekendsEveningsNights

    How did you hear about this position?

    Classified AdFriendRadioInternet

    Desired pay:

    When can you start working?

    What local area would you prefer to work in?

    Desired position:

    I hereby authorize CRIME PREVENTION OF FLORIDA, LLC, to disclose and obtain any information related to my employment records or educational records, including personal history, medical records, and police department records in this application.

    This authorization is executed with full knowledge and understanding that the information is for the official use of CRIME PREVENTION OF FLORIDA, LLC, and all statements made by me in this application are subject to verification. I am aware and accept that, in the event any investigation reveals misrepresentation, falsification, omission, or concealment of objective information, my application may be rejected.