Registration: Strategic Security Shiftboard

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APPLICANT INFORMATION
 

SUBCONTRACTORS
Are you working with Strategic Security Corp as a subcontractor:
 Yes  No
If yes, what subcontractor?

PERSONAL INFORMATION
Cell Phone Carrier
Date of Birth
SSN
Date Availability
Availability
Desired Location
I attest, under penalty of perjury that I am (check one of the following):
Alien Registration Number / USCIS Number
Expiration date autorized to work until, if applicable:

DIRECT DEPOSIT INFORMATION
Name of Financial Institution:
Routing Number
Account Number:
Type of Account:
I certify that I have read and understand this form. By signing this agreement, I authorize company to initiate credit entries to the account indicated above for payroll purposes. I also authorize company to initiate, if necessary, debit entries and adjustments for any credit entries made in error.
Refer to: Direct Deposit Information
 Yes
Please state your total number of withholding allowances:

(for example: just you then "1", you plus a child then "2", you, a spouse, a child then "3")


UNIFORM INFORMATION
Height
Weight
Ethnicity
Jacket Size
Shirt Size
Belt Size
Pants Size
Inseam/Hemming

ACADEMIC EDUCATION
Degree
Date Obtained
Educational Institution
Major
Degree
Date Obtained
Educational Institution
Major

EMPLOYMENT HISTORY
Present or Most Recent Employer
Telephone (required for verification)
Address
Employed (month and year)
From
To
Supervisor Name / Title
Salary (Start)
Salary (End)
Job Title / Description of Duties
Reason for Leaving
May we contact them?
 Yes  No
Previous Employer
Telephone (required for verification)
Address
Employed (month and year)
To
From
Supervisor Name / Title
Salary (Start)
Salary (End)
Job Title / Description of Duties
Reason for Leaving
May we contact them?
 Yes  No

ADDITIONAL INFORMATION
Have you ever been convicted of a crime?
 Yes  No
Are you able to pass a drug screening test?
 Yes  No
Do you ever worked for Rite Aid?
 Yes  No
If yes, in what capacity
Do you possess a valid driver's license?
 Yes  No
State
License #
Drivers Licence Expiration

CERTIFICATIONS
Do you posses a valid security guard license?
 Yes  No
1. State
1. License #
1. Expiration Date

2. State
2. License #
2. Expiration Date

3. State
3. License #
3. Expiration Date
Do you posses a concealed weapons permit?
 Yes  No
1. State
1. Permit #
1. Expiration Date

2. State
2. Permit #
2. Expiration Date

ADDITIONAL SKILLS
Qualifications - Please check all qualifications you hold (at least one must be checked):
18 Delta Medic (current)
Air Force - CCT
Air Force OSI-AST
Air Force PJ Qualified
Air Force Security Forces
Qualified
C.B.R.
Qualified Army Ranger
Qualified HazMat Technician
Qualified HazMat Operator
Qualified Carbine Operator
Qualified Public Information Officer
Qualified Disaster Planner
Driving Training Graduate
Bondurant Driving Training Graduate
BSR Driving Training Graduate
Certified Protection Professional
Certified Frauds Examiner (CFE)
CPR-Basic Qualified
Certified Emergency Manager
EMT Qualified
EMT-I Qualified
EMT-P Qualified
Executive Protection/PSS Certified
Explosive Ordnance (EOD) Qualified
Foreign Military
Instructor; Armed Guard
Instructor; Breaching
Instructor; C.B.R.
Instructor; Climbing
Instructor; Demolition
Instructor; Driving
Instructor; Heavy Weapons
Instructor; K-9
Instructor; Languages
Instructor; Law Enforcement Firearms
Instructor; Navy SAMI
Instructor; Navy SRFA
Instructor; Navy SRFB
Instructor; Navy VBSS
Instructor; NRA Law Enforcement Handgun
Instructor; Self Defense
Instructor; Sniper
Instructor; Urban Warfare
Instructor;Qualified Firearms
ITI Driving Training Graduate
Investigator; Detective / Special Agent
K-9 Law Enforcement Officer
Marine RECON Qualified
Medical Assistant Qualified
Medical Doctor
Military / Law Enforcement Breacher
Military / Law Enforcement CQB Training
Military Freefall Qualified
Military / Law Enforcement Police Qualified
Military Dog Handler
Navy Corpsman
Nightlife Security Professional
Physical Security Professional (PSP)
Physician Assistant Qualified
Project Management Professional (PMP)
Scotti Driving Training Graduate
Scout Sniper Qualified
SEAL Qualified
Special Forces
SpecOps Aviation
None of the above
Qualifications - Other
Languages - Please check all languages you are proficient (at least one must be checked)
Arabic
DARI
English
Farsi
French
German
Japanese
Pashayi
Russian
Sign-Language
Spanish
Tagalog
Tashiq
None of the above
Weapons - Please check all weapons you have received a qualification for (at least one must be checked)
M-16 Series Rifle
M-16A1 5.56mm Assault Rifle
M-203
M-24 Rifle
M-240 Machine Gun
M-249 Squad Automatic Weapon (SAW)
M-2B HB Machine Gun
M-4 Carbine Rifle
M-9
MK-19
PKM
RPG
RPK
Shotgun
None of the above
Trades - Please check all skills you are qualified for (at least one must be checked):
Accounting/Financial Specialist
Administrative Specialist
Aircraft Mechanic
Alarm Technician (Setting up central stations
alarm installation)
Armorer - Heavy Weapons
Armorer - Small Arms
Aviation Ordnance Specialist
Communication Specialist (Wide Area Trunking Systems
Interoperability)
Communication Specialist (VOIP)
Cook (FSS)
Demolition
Diesel Mechanic
Electronic Security ALS/IDS
Electronics Technician
Electrician
Emergency Management
Facilities Maintenance
Field Mechanic
Intel Analyst
Intelligence Specialist
IT Specialist
Logistician
Medic
Pilot - Fixed Wing
Pilot - Rotary Wing
Plumber
Sniper
Translator
Vehicle Mechanic
Welder
None of the above
Law Enforcement - Please check all the law enforcement and/or federal experience you have had
Border Patrol
CIA
DEA
Department of State
DOE
FBI
Federal Air Marshall
Federal Law Enforcement
Highway Patrol
Law Enforcement (Current)
Law Enforcement (Retired)
Local Police/Sheriff's Dept
Military Police
Secret Service
SWAT
Sworn LEO Dog Handler (K9)
Texas Rangers
US Marshall Service
Behavioral Analysis Unit
Crime Scene
Forensic
None of the above

BACKGROUND INFORMATION
Citizenship:
Do you have prior Military Service?
Air Force
Army
Australia
British
Canadian
Coast Guard
Marines
National Guard
Navy
New Zealand
South Africa
None of the above
DD214
 Yes  No
Do you have prior special operations community experience?
Air Force CCT
Air Force PJ
Green Beret
Navy SEAL
Rangers
SAS
USMC Force Recon
None of the above
What clearance(s) do you currently hold?
DOE 'Q'
Secret
Top Secret
Top Secret SCI
None of the above
Comments - Please enter any additional information you'd like us to consider.

REFERENCES
First Reference Full Name
First Reference Title
First Reference Agency/Company
First Reference Telephone No.
First Reference Email Address
Second Reference Full Name
Second Reference Title
Second Reference Agency/Company
Second Reference Telephone No.
Second Reference Email Address

AGREEMENTS
I certify that I have completely read, comprehend and take no exception to the employment agreement.
Refer to: Employment Agreement
 Yes
I certify that I have completely read, comprehend and take no exception to the non-disclosure agreement (NDA).
Refer to: Non Disclosure Agreement
 Yes
I certify that I have completely read, comprehend and take no exception to the employee agreement and consent to drug and/or alcohol testing.
Refer to: Substance Abuse Policy
 Yes
In connection with any application made by me, I understand that you may be requesting information from various Federal, State, and other agencies which maintain records concerning past activities relating to my credit, criminal, driving, civil, and other records and experiences, including claims involving me in the files of insurance companies, if any. These reports may also include information on education, experience, work habits, and performance, along with reasons for termination of employment from previous employers, if any. Without reservation, I authorize any party or agency contacted to furnish the above-mentioned information and release all parties involved from any liability and/or responsibility for doing so. I hereby consent to any potential employer obtaining such information from any company and/or any of their agents. This authorization is made in lieu of submission in an original, fax, or copy form.
Refer to: Background Check Agreement
 Yes
I certify that I have completely read, comprehend and take no exception to the U.S. Citizenship and Immigration Services Form I-9 and will upload a completed form.
Refer to: I-9 Form
 Yes
I certify that I have completely read, comprehend and take no exception to the job description.
Refer to: Job Description
 Yes
I certify that I have completely read, comprehend and take no exception to the company vehicle use policy.
Refer to: Company Vehicle Use Policy
 Yes
I certify that this information is complete and accurate. I understand that this information will be used to determine my employment considerations.
 Yes
I certify that I have access to a copy and have completely read, comprehend and take no exception to the employee handbook. By checking the box on the enrollment screen, you acknowledge that you understand and agree to be legally bound by the Agreement and the terms, conditions and notices contained or referenced herein. Checking the box creates an electronic signature that has the same legal force and effect as a handwritten signature.
Refer to: Employee Handbook
 Yes



Thank you for your interest!
 
 
New York, New York 10017
(212) 509-0547
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