Application Date: (mm/dd/yyyy)

Last Name:

First Name:

Middle Initial:

Street Address (Residence):

City:

State:

Zip (Residence):

Phone

Email:

Gender:
MaleFemaleTransgender

Marital Status:
SingleMarriedSeparated

Misdemeanor?
NoYes

Felony?
NoYes

Expungements?
NoYes

Have you recently been arrested for any matter for which you are on bail or on your
own recognizance pending trial?
NoYes

Educational Status (Check the highest level that you completed):
Elementary SchoolSecondary SchoolSome High SchoolG.E.DHigh School GraduateSome CollegeVoc./Tech SchoolAssociate DegreeBachelor Degree

Do you have prior security guard experience?
NoYes

Citizenship documentation will be required?
US CitizenEligible Non-CitizenIneligible Non-Citizen

How were you referred?

Date of Birth:

Age:

Are you a veteran of the U.S. Armed Forces?
NoYES – ArmyYES – Air ForceYES – MarinesYES - NavyYES – US Coast Guard

Are you on any Public Aid or Public Assistance?
NoYes

Are you currently working? If so where? How many hours per week and hourly
rate of pay?

This course is two weeks in length and taught weekdays from 8:30am to 4pm. Can
you commit to that schedule?