SPIE Employment Application

Applicant Name*:

Address*:

City, State and Zip Code*:

Telephone Number*:

Email Address*:

Date of Application*:

How did you hear about this position?

What days are you available for work

What hours or shift are you available for work?

If needed, are you available to work overtime?

On what date can you start working if you are hired?

Do you have reliable transportation to and from work?

Do you have any friends, relatives, or acquaintances working for SPIE* YesNo

If yes, state name & relationship:

Are you 18 years of age or older?* YesNo

Are you a U.S. citizen or approved to work in the United States?* YesNo

What document can you provide as proof of citizenship or legal status

Will you consent to a mandatory controlled substance test?* YesNo

Do you have any condition which would require job accommodations?* YesNo

If yes, please describe accommodations required below

Have you ever been convicted of a criminal offense (felony or misdemeanor)?* YesNo

If yes, please state the nature of the crime(s), when and where convicted and disposition of the case:

(Note: No applicant will be denied employment solely on the grounds of conviction of a criminal offense. The date of the offense, the nature of the offense, including any significant details that affect the description of the event, and the surrounding circumstances and the relevance of the offense to the position(s) applied for may, however, be considered.)

Please list below the skills and qualifications you possess for the position for which you are applying:

(Note: SPIE complies with the ADA and considers reasonable accommodation measures that may be necessary for eligible applicants/employees to perform essential functions.)

Name

Location (City, State)

Year Graduated

Degree Earned

Name

Location (City, State)

Year Graduated

Degree Earned

Name

Location (City, State)

Year Graduated

Degree Earned

Are you a member of the Armed Services?

What branch of the military did you enlist?

What was your military rank when discharged?

How many years did you serve in the military?

What military skills do you possess that would be an asset for this position?

Employer Name

Job Title:

Supervisor Name:

Employer Address:

City, State and Zip Code:

Employer Telephone:

Dates Employed:

Reason for leaving:

Employer Name

Job Title:

Supervisor Name:

Employer Address:

City, State and Zip Code:

Employer Telephone:

Dates Employed:

Reason for leaving:

Employer Name

Job Title:

Supervisor Name:

Employer Address:

City, State and Zip Code:

Employer Telephone:

Dates Employed:

Reason for leaving:

Can we contact your previous employers?* yesNo

If No, explain why (for each):

Do you have a valid NY/NJ/PA Security Guard License? Armed or Unarmed?

Please provide your Security Guard License Number:

The relationship between you and the SPIE is referred to as "employment at will." This means that your employment can be terminated at any time for any reason, with or without cause, with or without notice, by you or the SPIE. No representative of SPIE has authority to enter into any agreement contrary to the foregoing "employment at will" relationship. You understand that your employment is "at will," and that you acknowledge that no oral or written statements or representations regarding your employment can alter your at-will employment status, except for a written statement signed by you and either our Executive Vice-President/Chief Operations Officer or the Company's President.

Date: