Cauley Security Services

* Are you legally eligible to be employed in the United States? (Proof of identity and eligibility will be required upon employment):

Yes   No

* Are you at least 18 years or older? (If no, you may be required to provide authorization to work):

Yes   No

* Have you ever been convicted of a felony or a misdemeanor? (A conviction will not necessarily result in the denial of employment):

Yes   No

If Yes, please explain:

* Have you ever worked for Cauley Security Services before?:

Yes   No

If Yes, please provide details (Where/When/Job Title):

* Are you able to perform the essential functions of the job for which you are applying, with or without a reasonable accommodation?:

Yes   No

If no, please explain:

* When would you be available to begin work?:

* Type of employment desired:

Full-Time Part Time Either Seasonal

* Hourly rate desired:

* Are you currently employed?:

Yes   No

If so may we inquire of your present employer?:

Yes   No

If presently employed, why are you considering leaving?:

Give record of all High Schools, Colleges, Universities and Vocational/Technical Schools you have attended.

School Name & Location	Did you Graduate? If not, how many years did you complete?	Degree Received	Subjects Studied/Major
*	*	*

If you have completed any special courses, seminars and/or training that would help you to perform the position for which you are applying, please describe:

Give your full employment record, starting with your current or most recent employment

* From/To (1)

* Employer Name & Address (1)

* Employer Phone (1)

* Job Title (1)

* Supervisor Name & Title (1)

Duties (1)

* Reason for Leaving (1)

* Hourly Rate / Salary (1)

From/To (2)

Employer Name & Address (2)

Employer Phone (2)

Job Title (2)

Supervisor Name & Title (2)

Duties (2)

Reason for Leaving (2)

Hourly Rate / Salary (2)

From/To (3)

Employer Name & Address (3)

Employer Phone (3)

Job Title (3)

Supervisor Name & Title (3)

Duties (3)

Reason for Leaving (3)

Hourly Rate / Salary (3)

Name	Relationship	Phone Number

The facts set forth in this application and any supplemental information is true and complete to the best of my knowledge. I understand that, if employed, falsified statements on this application shall be considered sufficient cause for immediate discharge. I hereby authorize investigation of all statements contained herein and employers listed above to give you any and all information concerning my employment, and any pertinent information they may have, and release all parties from all liability for any damage that may result from furnishing same.

I understand that neither the completion of this application nor any other part of my consideration for employment establishes any obligation for the company to hire me. If I am hired, I understand that either the company or I can terminate my employment at any time and for any reason, with or without cause and without prior notice. I understand that no representative of the company has the authority to make any assurance to the contrary.

I understand that I am required to abide by all rules and regulations of the company.

* Signature (type name):
* Date:

* Were you in the military?:

Yes No

If yes, which branch?:

Army Navy Marines Air Force National Guard Coast Guard

What dates were you in the military? (from - to):

Type of discharge::

DD214?:

Yes No

* How long have you lived at your current address?:

* Previous address?:

* County & State of birth?:

* Home Telephone Number::

* Cellular Telephone Number::

* Emergency Contact Telephone Number::

* Emergency Contact Relationship to you (i.e. Mother, Uncle, Girlfriend, etc.)::

* What is the maximum number of hours you can work per week?:

* What shifts are you available to work? (check all that apply):

7a-3p 3p-11p 11p-7a

What shifts are you NOT available? (check all that apply):

7a-3p 3p-11p 11p-7a

* Can you work weekends?:

Yes No

What days are you NOT available for work?:

* What date are you available to start working for Cauley Security Services?:

* Where did you hear of the job opening?:

Post GazetteCraigslistIndeedTribune ReviewFriendMonsterOther

* Please indicate if you posses any of the following:(check all that apply):

Basic Computer Skills Supervisory Experience Customer Service Experience

* Are your currently CPR/AED certified?:

Yes No

If yes, when does you certification expire?:

* Are you currently certified in First Aid?:

Yes No

If yes, when does you certification expire?:

* Do you hold a current PA ACT 235 certification?:

Yes No

If yes, when does you certification expire?:

* What is your primary means of transportation to and from work?:

Public TransportationPersonal VehicleBikeOther

* Do you have a valid driver's license?:

Yes No

If yes, what is your drivers license state and number? (i.e. PA 00000000):

Do you drink?:

Yes No

If yes, how often?:

Do you smoke?:

Yes No

If yes, how often?:

Are you physically able to do the following? (check all that apply):

Walk from 30-45 minutes per hour Lift 35-40 lbs, when necessary Climb several flights of stairs, with ease, several times hourly Stand for several hours Run for short distances

* Which selection best describes your availability?:

Any shift, any day;Any shift weekdays;Any shift weekends;Day shifts only;Night shifts only;Evening shift only.

* How many years of experience do you have in the security industry?:

Over 20 years;Over 10 years;Over 5 years;Over 1 year;Less than one year;No experience.

* How many years of customer service work experience do you have?:

Over 20 years;Over 10 years;Over 5 years;Over 1 year;Less than one yearNo experience.

* Security work appeals to me because of::

The Uniform;Respectful work;Service to others;The Job is Easy;I Want a Career in Criminal Justice;The Money;Chance to Learn Something New.

* When I see a security officer the first thing I notice is::

His/Her facial expression;His/Her Demeanor;His/her Appearance;His/her Hygiene.

* I would consider the best employee to be the one that::

Does the most work;Gets paid the most money;Is the most efficient;Has the best personality;Works the hardest;Helps all of his co-workers;Is always professional.

* Your last level of formal education completed is::

10th grade;11th grade;12th grade;GEDTrade school (incomplete);Trade School (graduate);College (incomplete);College (graduate);

* Your longest term of employment with one employer was::

More than 20 years;More than 10 years;More than 5 years;More than 3 years;More than 1 year;6 months or more;Less than 6 months;Never employed.

* You have been working at your present site for six months and have made a number of friends. During your patrol, you observe someone you know and like going through an employee desk drawer. When you question your friend, he states that he was just killing a few minutes and that he was curious – he wondered what type of things this employee kept in her desk.  In these circumstances, because nothing was stolen, you advise your friend not to do this again, or you would have to write him up next time.  Is this response sufficient?:

Yes No

* You have been hired by Cauley Security Services and assigned to work at a lobby desk in a downtown office building. You do not have a home phone. What type of use can you make of your cell phone while at work::

You should use the desk phone, not your cell phone if you have to make personal calls; You should use your cell phone to make personal calls, but only when it is not busy at work; You should limit making outgoing calls at work, but it is OK to receive a few personal calls while at work; It is not a big deal and you can use your phone whenever you please since it is your phone; The only personal calls you make or receive should be based on family medical emergency; To avoid the appearance of always being on your cell phone, it is better to ask your friends to stop by, to visit you at work, particularly if it is near the end of your work shift and you are going to go home with this friend.

* Which of the following would merit the use of physical force on another person::

You have been physically assaulted by another person and are using only that force necessary to protect yourself from injury; Person has verbally abused and disrespected you in front of numerous witnesses and you use the necessary physical force to make them stop; A victim with a bloody nose approaches and identifies a nearby person as the individual that assaulted them, you did not witness the assault, you use the necessary force to detain the person until the authorities arrive; All of the above would merit using physical force;

* Have you been unemployed for more than 60 days? (You have not worked more than 40 hours during the 60 day period ending on the date you are hired by Cauley):

Yes No

* If yes, did you make Less than the $106,800 Social Security wage base?:

Yes No n/a

If yes, when were you unemployed? (give beginning and end dates):

* Type a paragraph below that explains why you would be an asset to Cauley Security Services. Give examples that demonstrate your abilities and attitude toward work.:

* Do you agree to ALL of the following?I authorize investigation of all statements contained in this application, including the resume. I also authorize the Company to contact my present employer (unless otherwise noted in this application) past employers, and references listed. I understand that the company may request an investigative consumer report from a consumer reporting agency that includes information relative to my character, reputation, personal characteristics, and mode of living. I also understand that under Federal Fair Credit Reporting Act, I have a right to make a written request to the company for the disclosure of the name and address of the consumer reporting agency so that I may obtain a complete disclosure of the nature and scope of their investigation.I authorize all persons, schools, past employers, my current employer, and all other referenced persons and organizations mentioned in this application and accompanying resume to provide the company with relevant information and opinion that may be useful to the company in making a hiring decision, and I release such persons and  organizations from any legal liability in making such statements.I consent to whatever physical examinations, including drug screening, and to release the company and company’s client  of the resulting medical information deemed necessary by the company in assessing my capability to do the work for which I am applying.I understand that if my employment is terminated by the company for dishonesty, breach of trust, or criminal acts, the proper authorities may be notified, and I may also be prosecuted. I also understand that, if hired, I may not hold other employment, nor engage in sales, investments, or other activities that may create a conflict of interest with my position in this company.I understand that my continued employment will depend upon the successful completion of work assigned to me during a new hire period of up to ninety (90) days and upon my continued successful performance I have read, understand and agree to the above.I understand that I am responsible to return all uniform items issued to me in a clean and pressed manner, and that should I fail to return a uniform item, or return a uniform item that is not cleaned and pressed, that I am responsible to pay for the loss of said uniform item, and voluntarily agree that the replacement cost or the cost of professional laundering can be deducted by Cauley Detective Agency, Inc. from my last paycheck.I understand that this application does not, by itself, create a contract of employment, and that, if hired, MY EMPLOYMENT IS “AT WILL” AND FOR NO DEFINITE PERIOD OF TIME, and MAY BE TERMINATED AT ANY TIME, regardless of the date of payment of wages. I understand that NO PERSON IS AUTHORIZED TO CHANGE ANY OF THE TERMS MENTIONED IN THIS EMPLOYMENT APPLICATION FORM.

Do you agree?:

Yes No