Employment Form

Required

PPS pledges equal access to employment, facilities and programs, regardless of race, color, creed, religion, sex, sexual orientation, age, disability, national origin, veteran or marital status.

APPLICATION DATE
JOB APPLIED FOR

How did you learn about this position? (if applicable)

NewspaperEmployment OfficeJoblineFriendPPS Website

PERSONAL INFORMATION

YOUR-NAME (LAST, FIRST, M.I.)
HOME TELEPHONE

STREET ADDRESS
WORK TELEPHONE

CITY, STATE, AND ZIP CODE
OTHER CONTACT NUMBER

PERSONAL REFERENCE
(Name, Address, Phone Number)
PERSONAL REFERENCE
(Name, Address, Phone Number)

The Immigration Reform and Control Act of 1986 requires that all employees verify proof of legal right to work in the U.S.A. U.S. Passport or combination of government-issued picture identification with a birth certificate, social security card, or Alien Registration card are examples of proof. If hired, can you provide as required?

Within the past 3 years, do you have any moving
violations on your driving record?

Has your driver's license ever been suspended?

Have you ever been convicted of a crime?

Are you currently on probation or parole?

Work Schedule

Select One or More
PermanentTemporarySpecial EventsOn-Call
Select One or More
Full TimeFull or Part TimeJob SharePart TimeIntermittent
Date you can report for work

Permits

State Guard Permit

State Firearm Permit

State Baton Permit

State Mace/OC Permit

CCW

PC 832

P.O.S.T Certificate

Others (Please list as: Permit Type – Permit Number – Permit Expiration)

Military History
(Attach a scanned copy of your DD214/DD215)

Type of discharge

Date of Entry
(M-D-Y)
Date of Discharge
(M-D-Y)
Branch of Service

Area of Armed Conflict

EDUCATION / TRAINING HISTORY

Name and Location of School
Course of Study (List Major)
Credit Earned
Graduate

Degree or Certificate Received
Name and Location of School
Course of Study (List Major)
Credit Earned
Graduate

Degree or Certificate Received
Name and Location of School
Course of Study (List Major)
Credit Earned
Graduate

Degree or Certificate Received

ADDITIONAL LICENSE / REGISTRATION / CERTIFICATE

List any other licenses or certificates that are applicable to the position applied for.

Description
State
Number
Expiration

Description
State
Number
Expiration

SPECIALIZED SKILLS AND KNOWLEDGE

List any skills or knowledge that show your ability to perform the job for which you are applying (such as typing speed, computer skills, foreign languages, tactical training, investigative training, etc.).

WORK HISTORY
(A Resume Will Not Substitute But May Be Attached)

What you write in this section will be used to decide if you meet the "To Qualify" section of the job announcement. List ONLY the
job(s), paid or volunteer where you got experience that qualifies you for the job you are applying for. Clearly describe all of your duties starting with your most recent job.

  • If the qualifying experience shown on the job announcement is not the main duty but only part of the duties you performed in a job you are listing, you must include the percentage of time actually spent on the qualifying experience in the Description box. For example, performing vehicle patrols 4 hours of a 40 hour week = 10%; or 5 hours of a 20 hour week = 25%.
  • Complete each box. If you do not provide all the information required in this section, no credit will be given for that job. If you need additional space to list job duties, attach a separate sheet; clearly identify the job you're describing.
  • Attach additional pages if you need to list more jobs. (Be sure to identify additional jobs by numbering them 4,5,6 etc.)
Name of Employer (Job 1)
Employer's Address and Phone Number

Kind of Business
Supervisor's Name and Phone Number

Your Job Title
Reason for Leaving

From (Month - Year)
To (Month - Year)
Hours/wk (Average)
Supervision / Leadwork (Check the areas you were responsible for)

Assigning and Reviewing WorkHandling Disciplinary ProblemsRating Work PerformanceResponding to GrievancesHiring or Recommending Hiring
Description of Duties
Name of Employer (Job 2)
Employer's Address and Phone Number

Kind of Business
Supervisor's Name and Phone

Your Job Title
Reason for Leaving

From (Month - Year)
To (Month - Year)
Hours/wk (Average)
Supervision / Leadwork (Check the areas you were responsible for)
Assigning and Reviewing workHandling Disciplinary problemsRating Work PerformanceResponding to GrievancesHiring or Recommending Hiring
Description of Duties
Name of Employer (Job 3)
Employer's Address and Phone Number

Kind of Business
Supervisor's Name and Phone

Your Job Title
Reason for Leaving

From (Month - Year)
To (Month - Year)
Hours/wk (Average)
Supervision / Leadwork (Check the areas you were responsible for)
Assigning and Reviewing workHandling Disciplinary problemsRating Work PerformanceResponding to GrievancesHiring or Recommending Hiring
Description of Duties

Additional Jobs Attachment

If you have more than one document (file) to attach to this application, please zip the files and upload the zipped file.


File Size: 1500KB Maximum
File Types: .doc .docx .pdf .txt .zip

CERTIFICATION AND SIGNATURE

By Submitting this application:

I understand that employment is contingent upon satisfaction of pre-employment screening which may include health
examination(s) and other requirements. I hereby authorize employers, schools, and persons named as references to provide information that may be required to arrive at an employment decision. I also agree to the inclusion of the results in my personnel records. I release Personal Protective Services, Inc. and the parties providing the information from any and all liability for any damage resulting from the release of such information.

I certify that the information I have provided on this application and any attached documents are true, complete, and correct to the best of my knowledge. If my statements are found to be untrue, incomplete, or otherwise not in good faith, I understand that the consideration for employment may be denied, or if hired, my employment may be terminated.

I understand that if hired my employment may be terminated at any time, with or without cause, with or without advance notice, at the discretion of the company or myself. I further understand that no management official other than the owner of Personal Protective Services, Inc. has any authority to enter into any agreement contrary to the foregoing or make any oral assurance or promise of continued employment.

Please sign with your full name below.

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