1. technology and computing
2. consumer electronics
3. telephones
4. mobile phones

Instructions for application:!
!
Fill out the pdf as completely as you can. Some fields
are required and must be completed to be submitted
to IPSA for consideration of employment.!
!
Once PDF is complete, print a copy and bring to
IPSA offices at 2700 N. Central Ave., Suite 370,
Phoenix, AZ 85004.
!
OR!
!
Save PDF and send as an attachment to: !
!
info@ipsasecurityservices.com!
!
!
Thank you for your interest in working with IPSA
Security Services. We will contact you after receiving
your application.
Application for Employment
PLEASE READ CAREFULLY. ANSWER COMPLETELY AND ACCURATELY. Only completed applications will be evaluated, do not indicate, “see
resume”. If you require accommodation due to a disability in order to complete the application, please let us know what you require.
When considered applicant for all positions without regard to race, color, religion, sex, national origin, marital or veteran status, the presence of any
physical or mental condition or disability, or any other legally protected status.
APPLICANT INFORMATION
Name:
Date:
Have you ever worked under a different name?
No
Yes
Please list all names used:
Present Address:
Street
Apt#
City
State
Zip
Email Address:
Main Phone:
Other Phone:
Position (s) Applying for:
Referred by:
Do you have the legal right to work in the US?
No
Yes
If hired, can you provide proof you are at least 18 years of age?
No
Yes
Have you ever been terminated or asked to resign?
No
Yes
Please explain:
Where & When?
Local Office
Position:
From (MM/YY)
To (MM/YY)
Reason for Leaving:
Are you related to an IPSA employee?
No
Yes
Please explain:
AVAILABILITY
Date available to begin work:
I am available to work the following:
Full- time
Part-time
Shifts you prefer to work:
Day
Graveyard
Swing
Times you cannot work:
Weekends
Overtime
MILITARY SERVICE
List any US Military Service, Rank, Branch or Service, Special Skills Acquired, Etc.
IPSA Security Services Application for Employment
Page !1
Any
Application for Employment
DRIVER HISTORY
Do you possess a valid driver’s license?
No
Yes
Are there any restrictions on you license?
No
Yes
License #:
State:
Please explain:
How many citations have you received in the past three (3) years?
Have you had any automobile accidents in the past five (5) years?
No
Yes
If yes, please explain:
Do you have a car or other reliable transportation?
No
Yes
Do you have automobile liability insurance?
No
Yes
CRIMINAL BACKGROUND
Have you ever been convicted of a crime (Felony or Misdemeanor)?
No
Yes
If yes, please provide details, dates, places, charges, final disposition. Do not include moving or parking violations or infractions. Do
include anything more serious (a conviction will not necessarily disqualify you from employment.)
Are you now awaiting trial or sentencing for any crime?
No
Yes
If yes, provide details:
PERMITS / CERTIFICATES
Do you have a current guard card or license?
License #:
No
Expiration Date:
Yes
Where was it obtained?
Do you have any other permits / certificates? Please complete the following:
Additional Guard Card:
Exposed firearm permit:
Concealed weapon permit:
Other:
No
No
No
No
Yes
Yes
Yes
Yes
Number:
Number:
Number:
Number:
Expires:
Expires:
Expires:
Expires:
Have you ever held a security clearance?
No
Yes
Level of Clearance:
Agency:
Date Granted:
Date Terminated:
Have you ever had a security clearance or license suspended, denied or revoked?
Please explain:
IPSA Security Services Application for Employment
Page !2
No
Yes
Application for Employment
EDUCATION
Type of School
Name of School & Location
High School
College Bus. or Trade School
Professional School
Other
No. Years Completed
Major or Degree
!
Are you currently taking any educational Courses?
Please describe:
EMPLOYMENT
List all your previous employers for the past seven (7) years. Start with your current or most recent employer. Include self-employment
and part-time jobs.
Employer:
Phone:
Employer Address:
May we contact?
Employed Dates:
Base Pay:
Position:
Supervisor’s Name:
No
Yes
No
Yes
No
Yes
Per
Summary of Duties:
Reason for leaving:
Employer:
Phone:
Employer Address:
May we contact?
Employed Dates:
Base Pay:
Position:
Supervisor’s Name:
Per
Summary of Duties:
Reason for leaving:
Employer:
Phone:
Employer Address:
May we contact?
Employed Dates:
Base Pay:
Position:
Supervisor’s Name:
Summary of Duties:
Reason for leaving:
IPSA Security Services Application for Employment
Page !3
Per
Application for Employment
PERSONAL REFERENCES
List 3 personal references. Do not include relatives, in-laws, or people who share your current address. Give complete and accurate
information.
1.
Name:
Relationship:
Address:
Phone:
Years Known:
1.
Name:
Relationship:
Address:
Phone:
Years Known:
1.
Name:
Relationship:
Address:
Phone:
Years Known:
BACKGROUND INVESTIGATION DATA
IPSA Security Services will conduct a background check on applicants selected for employment. As part of your background check,
you must provide the information requested below for the last seven (7) years for your residence. If you need additional space, use a
separate sheet or include in your email to us at (jobs@ipsasecurityservices.com) or fax (602) 296-0008.
Residence: List all your addresses for the past seven years, starting with your current address.
Current Address (Please note: This must be your residence, not your mailing address)
1.
How Long?
Street
Apt#
City
State
Street
Apt#
City
State
Street
Apt#
City
State
Street
Apt#
City
State
Street
Apt#
City
State
2.
How Long?
3.
How Long?
4.
How Long?
5.
How Long?
!
PLEASE READ CAREFULLY, SIGN AND DATE BELOW** I hereby declare that the information provided by me in this application for employment is
true, correct and complete to the best of my knowledge. I understand that if employed, any misstatement, false statements or omission of fact on this
application shall result in rejection of this application or termination of employment. I understand that this application is valid for thirty days; I must
reapply to be considered after this period. I understand that all job offers made by an authorized representative of IPSA Security Services are contingent
upon passing a drug screen, presenting documents to conform to the Immigration Reform and Control Act and form I-9, and background investigation.
In consideration of my employment, I agree to conform to the rules and regulations of IPSA Security Services and that my employment and
compensation can be terminated with or without cause, and with or without notice at any time, at the option of the company or myself. I understand that
only the Chief Executive Officer of the Company has the authority to enter into any employment agreement for specified period of time and that such
agreement must be in writing. I also agree that if I am hired, as consideration of my employment I will be bound by and accept as a condition of my
employment, the terms of the IPSA Dispute Resolution Plan Rules and Summary Plan Description (IPSA Dispute Resolution Program)
Signature:
IPSA Security Services Application for Employment
Date:
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