Step 1 of 4 - APPLICANT INFORMATION 0% APPLICANT INFORMATIONName* First Middle Last Email* Enter Email Confirm Email Mobile Phone*Social Security #* Address* Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Date of Birth* MM slash DD slash YYYY Place of Birth* City State / Province / Region Emergency Contact Phone*Emergency Contact Name/ Relationship* WORK HISTORYPlease list all jobs you have worked in the last 5 years:*EmployerPositionDate RangeReason for Leaving PRE-EMPLOYMENT QUESTIONNAIREAre you looking for full-time or part-time work?* Full-time Part-time Are you available to work any day of the week and/or time of day, including nights and weekends?* Yes No If the answer to the above question was "No", please explain: Do you have a valid commissioned or non-commissioned private security license from the State of Texas?* Yes No Security License Expiration Date* MM slash DD slash YYYY Have you ever been convicted of a felony level offense?* Yes No Have you been convicted of any Class A or Class B Misdemeanors in the last 5 years?* Yes No Do you have your own reliable transportation, and will be able to make it to each and every assigned shift?* Yes No Do you have a reliable cell phone, and will be able to quickly respond to all calls and texts from POM supervisors and staff?* Yes No Are you free of any weather sensitivities, and if necessary, will be able to work in all weather conditions, to include: heat, cold, rain, snow, and ice?* Yes No SIGNATUREWith my digital signature below, I affirm that all the information provided in this document is correct and true to the best of my knowledge, and I authorize The Peace of Mind Group to collect and retain this information for hiring and employment purposes.*Sign your name in the boxNameThis field is for validation purposes and should be left unchanged.