Employment Application

An Equal Opportunity Employer

We consider applicants for all positions on the basis of qualifications and without regard to race, creed, color, religion, sex, national origin, age, veteran or marital status, disability or any other classification protected by federal, state or local law.

Answer each question fully and accurately. No action can be taken on this application until you have answered all of the questions.

Positions(s) Applied For: 
Date of Application: 
How did you learn about the company?
(circle one)
First Name: 
Middle Initial: 
Last Name: 
Other Names (Maiden or Aliases): 
Telephone Number(s) where we can contact you:
Home: 
Work: 
Alternate: 
Current Address:
City: 
State: 
How long at this address? 
Email: 
Are you seeking
(Please select all that apply): 
What date could you start? 
Shift Availability(Please select all that apply)
Sunday: 
Monday: 
Tuesday: 
Wednesday: 
Thursday: 
Friday: 
Saturday: 

Previous Addresses for the Past 10 Years: If you have not been at your locations for 10 years, please list the second most current first

2. Address: 
2. City: 
2. State: 
2. Zip: 
2. Name Used: 
2. From: Mo/Yr: 
2. To: Mo/Yr: 


3. Address: 

3. City: 
3. State: 
3. Zip: 
3. Name Used: 
3. From: Mo/Yr: 
3. To: Mo/Yr: 


4. Address: 

4. City: 
4. State: 
4. Zip: 
4. Name Used: 
4. From: Mo/Yr: 
4. To: Mo/Yr: 


5. Address: 

5. City: 
5. State: 
5. Zip: 
5. Name Used: 
5. From: Mo/Yr: 

Level of Education

Highest level of education achieved:
School Name: 
School State: 
School City: 
Diploma/Degree: 
Graduation Date: 

WORK HISTORY FOR THE PAST 10 YEARS:

May we contact your current employer? 
1. Name of Employer (most recent):
1. Job Title:
1. Pay Rate:
1.Address (City & State):
1. Job Duties:
1. Telephone Number(s):
1. Supervisor:
1. Reason for Leaving:
1. Employed From Date:
1. Employed To Date:


2. Name of Employer (most recent):

2. Job Title:
2. Pay Rate:
2.Address (City & State):
2. Job Duties:
2. Telephone Number(s):
2. Supervisor:
2. Reason for Leaving:
2. Employed From Date:
2. Employed To Date:


3. Name of Employer (most recent):

3. Job Title:
3. Pay Rate:
3.Address (City & State):
3. Job Duties:
3. Telephone Number(s):
3. Supervisor:
3. Reason for Leaving:
3. Employed From Date:
3. Employed To Date:


4. Name of Employer (most recent):

4. Job Title:
4. Pay Rate:
4.Address (City & State):
4. Job Duties:
4. Telephone Number(s):
4. Supervisor:
4. Reason for Leaving:
4. Employed From Date:
4. Employed To Date:


5. Name of Employer (most recent):

5. Job Title:
5. Pay Rate:
5.Address (City & State):
5. Job Duties:
5. Telephone Number(s):
5. Supervisor:
5. Reason for Leaving:
5. Employed From Date:
5. Employed To Date:

GAPS IN WORK HISTORY: Please explain any gaps in your employment history.



REFERENCES:

Provide three (3) references that have knowledge of your work performance.
PLEASE DO NOT INCLUDE RELATIVES OR FRIENDS.

Reference one name:
Reference one address:
Reference one relationship:
Reference one telephone:


Reference two name:

Reference two address:
Reference two relationship:
Reference two telephone:


Reference three name:

Reference three address:
Reference three relationship:
Reference three telephone:


Statement of Interest Please explain in at least 50 words why you are interested in employment at CISS


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Callins Investigations  & Security Services, P.A., P.O. Box 950180 Lake Mary, FL 32795 • Phone: (407) 324-3949 • Fax (407) 324-2650
1-800-540-6475 • email: info@callinsinvestigations.com

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