Nexus Security Firm Employment Application

FOR OFFICIAL USE ONLY

AgencyAuthorizedSignature

Date

Broadband/ClassCode

Status

PERSONAL

Birth Date

Driver's License

Height

Weight

Are you a US Citizen

Yes

EDUCATIONAL BACKGROUND

Name of College/ University /Professional School

location

Start Date

End Date

Credit Hours Earned QTR

Credit Hours Earned SEM

Field of Study

Type of Degree Earned

Your Name, if different while attending school

JOB-RELATED TRAINING OR COURSE WORK

Name of School

location

Credit Hours Earned Clock

Start Date

End Date

Credit Hours Earned Class

Field of Study

Training Completed

Yes

Your Name, if different while attending school

Licensure, Registration, Certification

License

Number

Date Received

Expiration Date

State Licensing Agency

CONTACT INFORMATION

Name

Address

City

Country

State

Zip code

Phone *

Alternate Phone

Email Adress *

GENERAL INSTRUCTIONS

"Complete all information within this application in its entirety."

Note: A separate application must be submitted for each vacancy. Photocopies are acceptable.)"

POSITION APPLIED FOR

Title

Date Available

PERIODS OF EMPLOYMENT

Name of Present or Last Employer

Address

Your Job Title

Supervisorʼs Name

Phone No.

Start Date

End Date

Hours per Week

Your Name if Different During Employment

Duties and Responsibilities

Reason For Leaving

KNOWLEDGE / SKILLS / ABILITIES (KSAs)

List KSAs you possess and believe relevant to the position you seek. Guide

EXEMPTION FROM PUBLIC RECORDS DISCLOSURE

Are you a current or former law enforcement officer, other covered employee, or the spouse or child of one, whose information is exempt from public records disclosure under Section 119.0714)(d), Florida Statutes F.S.

Yes

BACKGROUND INFORMATION

Have you ever been convicted of a felony or a first-degree misdemeanor?

Yes

If "YES", what charges?

Where convicted?

Date of Conviction

Have you ever pled nolo contendere or pled guilty to a crime which is a felony or a first-degree misdemeanor?

Yes

If "YES", what charges?

Where?

Date

Have you ever had the adjudication of guilt withheld for a crime which is a felony or a first-degree misdemeanor?

Yes

If "YES", what charges?

Where?

Date1

Are you a U.S. citizen?

Yes

If no, are you legally authorized to accept employment with the specific hiring authority to which you are applying?

To your knowledge, do you have any relatives working in this agency?

Yes

Add a field for the applicant's signature.

Date

VETERANSʼ EMPLOYMENT PREFERENCE

Applicant Full Name

Position Applied For

FCRA Authorization to Obtain a Consumer Report

Add the authorization statement for background and credit checks.

Print Name

Date

Signature

Clear