SECURITY APPLICATION - Club Smiles - Poughkeepsie, NY

Name *

First

Last

Applying for position at: *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Primary Phone #: *

Email Address: *

EMPLOYMENT HISTORY
Please list chronologically, beginning with most recent experience.

Employer: *

Address/City: *

Employment Start and End Date: *

Supervisor: *

Phone #: *

Type of Work: *

Reason For Leaving: *

Employer 2: *

Address/City: *

Employment Start and End Date: *

Supervisor: *

Phone #: *

Type of Work: *

Reason For Leaving: *

Employer 3: *

Address/City: *

Employment Start and End Date: *

Supervisor: *

Phone #: *

Type of Work: *

Reason For Leaving: *

EDUCATION

Level of Education/Major/Diplomas/Years Completed

Personal Information
Member of the Drug-Free Workplace Network. Pre-Employment Drug Testing is a Requirement.

Are you legally authorized to work in the U.S.?: (If hired, you will be required to provide proof of work authorization.) *

Yes
No

Do you have your security license? *

Yes
No

Briefly describe skills you may have that you acquired in other employment or armed forces:

Have you ever been convicted of a crime (felony)?: *

Yes
No

If yes, give details: (Convictions are not automatic bar to employment)

If you possess particular skills or any others you wish to mention, please list:

Tell us a little about yourself and what you're looking for: *

Are you presently employed?: *

Yes
No

If so, may we contact your present employer?: *

Yes
No

If hired, when would you be available?:

Employment References:
List individuals familiar with your job qualifications (No relatives or personal friends).

Name of Reference:

Occupation:

Relationship/How long have you known:

Phone#:

Name of Reference 2:

Occupation:

Relationship/How long have you known:

Phone#:

GigglesWorld Corp. is committed to the employment and advancement of minorities, females, individuals with disabilities and veterans.

How were you referred to this job?: *

Please read carefully before submitting your application All information contained in this application is true and correct to the best of my knowledge and belief. I understand that misrepresentations or omissions of any kind may result in denial of employment or be cause for subsequent dismissal if I am hired. I authorize the company to investigate my responses on this application and contact any or all of my former employers or any individuals familiar with me or my employment background for the purpose of verifying any information I have provided and/or for the purpose of obtaining any information whether favorable or unfavorable about me or my employment. I voluntarily and knowingly fully release and hold harmless any person or organization that provides information pertaining to me or my employment. I understand that upon receiving a job offer, a drug screening may be required. (Note: If this is a job requirement, you will be notified.) Regardless of whether or not I become employed by the company, I recognize that this application is not and should not be considered a contract of employment. I understand that employment at the company is on an at-will basis and that my employment may be terminated with or without cause, and without notice, at any time, at my option or the company's unless specifically provided otherwise in a written employment contract. I further understand that no company employee or representative has the authority to enter into a contract regarding duration or terms and conditions of employment other that an officer or official of the company and then only by means of a signed written document. We have a policy of no smoking on the premises.

Submission Confirmation: *

Check this box to certify that you have read and accept the above statement.

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Are you having issues with our application? Please let us know by sending an email to inquiries@clubsmiles.com