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Howe Security Pre-Employment Questionnaire

Section 1: Personal Information

Name
(last name first) SSN

Current Address
City

State ZIP

Permanent Address City

State ZIP

Phone Referred by:

Section 2: Employment Desired

Position Start Date

Date you can start Are you legally authorized to work in the U.S.?
Yes      No

Are you employed now?
Yes      No If so, may we check with your employer?
Yes      No

Have you applied with Howe Security previously?
Yes      No If yes, please give date

Section 3: Education & Military

High school
(name and location) Did you graduate? Yes      No

College
(name and location) Did you graduate? Yes      No

Trade or
correspondence school
(name and location) Certificate received? Yes      No

Special areas of study or research work?

Special training?

Special skills?

U.S. Military service? Yes      No Rank

Section 4: Past Employment     List last four employers, most current first

Employer 1 From / to

Salary Position

Reason for leaving

Employer 2 From / to

Salary Position

Reason for leaving

Employer 3 From / to

Salary Position

Reason for leaving

Employer 4 From / to

Salary Position

Reason for leaving

Section 5: References     List three persons to whom you are NOT related and have known for at least one year.

Reference 1

Name Phone

E-mail Relationship

Reference 2

Name Phone

E-mail Relationship

Reference 3

Name Phone

E-mail Relationship

Section 6: Sign & Submit

Authorization
“I certify that the facts contained in this application are true and complete to the best of my knowledge and understand
that if employed, falsified statements on this application shall be grounds for dismissal.

l authorize investigation of alt statements contained herein and the references and employers listed above to give you any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise and release the Howe security from liability for any damage that fiiy result from utilization of such information.

I also understand and agree that no representative of the Howe Security has any authority to enter into any agreement for employment for any specified period of time or to make any agreement contrary to the foregoing, unless it is in writing and signed by an authorized company representative.

This waiver does not permit release or use of disability-related or medical information in a manner prohibited by the
Americans with Disabilities Act (ADA) and other relevant federal and state laws."

Today’s date E-signature

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Section 1: Personal Information
Name (last name first)		SSN
Current Address		City
State		ZIP
Permanent Address		City
State		ZIP
Phone		Referred by:
Section 2: Employment Desired
Position		Start Date
Date you can start		Are you legally authorized to work in the U.S.? Yes No
Are you employed now? Yes No		If so, may we check with your employer? Yes No
Have you applied with Howe Security previously? Yes No		If yes, please give date
Section 3: Education & Military
High school (name and location)		Did you graduate? Yes No
College (name and location)		Did you graduate? Yes No
Trade or correspondence school (name and location)		Certificate received? Yes No
Special areas of study or research work?
Special training?
Special skills?
U.S. Military service? Yes No		Rank
Section 4: Past Employment List last four employers, most current first
Employer 1		From / to
Salary		Position
Reason for leaving
Employer 2		From / to
Salary		Position
Reason for leaving
Employer 3		From / to
Salary		Position
Reason for leaving
Employer 4		From / to
Salary		Position
Reason for leaving
Section 5: References List three persons to whom you are NOT related and have known for at least one year.
Reference 1
Name		Phone
E-mail		Relationship
Reference 2
Name		Phone
E-mail		Relationship
Reference 3
Name		Phone
E-mail		Relationship
Section 6: Sign & Submit
Authorization “I certify that the facts contained in this application are true and complete to the best of my knowledge and understand that if employed, falsified statements on this application shall be grounds for dismissal. l authorize investigation of alt statements contained herein and the references and employers listed above to give you any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise and release the Howe security from liability for any damage that fiiy result from utilization of such information. I also understand and agree that no representative of the Howe Security has any authority to enter into any agreement for employment for any specified period of time or to make any agreement contrary to the foregoing, unless it is in writing and signed by an authorized company representative. This waiver does not permit release or use of disability-related or medical information in a manner prohibited by the Americans with Disabilities Act (ADA) and other relevant federal and state laws."
Today’s date		E-signature
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