Employment - Nexus Security Firm

For Official Use Only

Agency Authorized Signature

Date

Broadband / ClassCode

Status

Personal

Birth Date

Driver License

Height

Weight

Are you a US citizen

Yes

No

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 College/ University /Professional School

Name of School

location

Credit Hours Earned Clock

Start Date

End Date

Credit Hours Earned Class

Field of Study

Training Completed

Yes

No

Your Name, if different while attending school

Licensure, Registration, Certification

License

Number

Date Received

Expiration Date

State Licensing Agency

Contact Information

First Name

Last Name

Address

Address Line 1

Address Line 2

City

State

Zip Code

Country

Phone/Mobile

Alternate Phone/Mobile

Date Received

Email

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 Employement

Name of Present or Last Employer

Address

Your Job Title

Supervisorʼs Name

Phone/Mobile

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

No

Background Information

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

Yes

No

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

No

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

No

If "YES", what charges?

Where?

Date

Are you a U.S. citizen?

Yes

No

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

No

Add a field for the applicant's signature.

Date

Veteran's Employment Preference

Applicant Full Name

Position Applied For

Date of Conviction

FCRA Authorization to Obtain a Consumer Report

Add the authorization statement for background and credit checks.

Print Name

Date

Protect, Serve, and Excel in Your Career

Join the Nexus Security Team

For Official Use Only

Personal

Educational Background

Job Related Training or Course Work

Licensure, Registration, Certification

Contact Information

General Instructions

Position Applied for

Periods of Employement

Knowledge / Skills / Abilities (KSAs)

Exemption from Public Records Disclosure

Background Information

Veteran's Employment Preference

FCRA Authorization to Obtain a Consumer Report