SecureWorld Protective Services Corp.

* mandatory field

First Name *

Last Name *

Middle Initials

Social Insurance

Present Address *

Postal Code

Permanent Address *

Postal Code

Country *

Telephone *

Cell

Pager

Email *

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Is there any information we would need about your name or use of another name to enable us to check your work record? Please specify:

Do you have any relatives who are presently (or formerly been) employed by SecureWorld Corp.?

How are you referred to SecureWorld Corp.?

Have you ever been convicted of a criminal offence? Yes No
If yes, please explain:

Are you bondable? Yes No

High School

Address

Year Completed

College

Address

Year Completed

Technical Training

Address

Year Completed

Other

Address

Year Completed

Company Name *

Company Name

Company Name

Position Held *

Position Held

Position Held

Company Address *

Company Address

Company Address

Telephone Number *

Telephone Number

Telephone Number

Manager / Supervisor Name *

Manager / Supervisor Name

Manager / Supervisor Nam

Employed From: To: *

Employed From: To:

Employed From To

Wage / Salary *
$

Wage / Salary
$

Wage / Salary
$

Reason for leaving *

Reason for leaving

Reason for leaving

Name	Name	Name
Years Known	Years Known	Years Known
Address	Address	Address
Telephone	Telephone	Telephone
Occupation	Occupation	Occupation

When would you be available to begin work?

Part Time Full Time

Do you drive?

Yes No

Do you have any objection to working overtime?

Yes No

Can you work overtime without prior notice?

Yes No

Can you work on weekends?

Yes No

Can you travel if required by this position?

Yes No

If your application receives favorable consideration,
What salary / hourly rate would you require? Hour Year $

BACKGROUND CHECK AND RELEASE OF INFORMATION AND RESEARCH
Please read this section carefully and acknowledge your understanding by signing your name in the space provided below. 1.Consent to Conduct Background Investigation As a condition of and in regard for SecureWorld Corp. consideration of this application, I authorize SecureWorld Corp. to investigate my personal and employment history. I understand that this background investigation will include, but will not be limited to, verification of all information on this application, as well as interviews with past employers. I further authorize SecureWorld Corp. to conduct this investigation and to discuss the results of this investigation in connection with my application for employment. 2. Consent to Contact Past Employers I authorize SecureWorld Corp. to contact all employers listed in this application (except those specifically excluded) for reference purposes. I further authorize all current or previous employers and/supervisors to discuss my relevant personal and employment history with SecureWorld Corp., I consent to the release of such information orally or in writing and hereby release them from all liability and agree not to take legal action for defamation or other claims based upon any statements they make to any representative of SecureWorld Corp. 3. Consent to Contact Government Agencies I authorize any agent, attorney or representative of SecureWorld Corp. to receive a copy of any information obtained in the file of any federal, provincial or local court, governmental agency, law enforcement agency or investigator concerning or relating to me. I further consent to the release of such information and waive any right under provincial law concerning notification of the request of a release of such information. In the event a provincial Law does not provide for prospective employers to have access to information, I hereby delegate SecureWorld Corp. as my agent for receipt of information. I understand that the scope of this investigation will be limited to criminal and/or civil records that relate to my honesty, integrity and/or liabilities. 4. Cooperation With Investigation I agree to fully cooperate in SecureWorld Corp. background investigation and to sign any waivers or releases that may be necessary to obtain access to relevant information. In the event that any former employer or federal, provincial or local governmental agency will not release reference information or criminal history information directly to the employer. I agree to personally request such information to the extent permitted by law. 5. Falsification Statement I understand that my falsification or willful omission of facts made in this application or in connection with any background investigation may be sufficient grounds for rejection of this application, or if discovered after an offer of employment, is grounds for immediate dismissal. 6. Employment At Will In consideration of my employment, I agree to conform to the rules and regulations of SecureWorld Corp. and my employment and compensation is at will in that they can be terminated with or without cause, and with or without notice at any time, at the option of either SecureWorld Corp. or myself, except as otherwise provided by the law. I understand that no one, other that the officers of SecureWorld Corp. have the authority to enter into any agreement for employment for any specified period of time or to make any agreement or contact to the foregoing, and that any premises to the contrary will only be relied upon by me if they are in writing and signed by and officer of SecureWorld Corp. I certify that all of the statements made on this application for employment are true, correct and complete to the best of my knowledge.

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