Name *

First

Middle

Last

Address

Address Line 1

City

State

Zip Code

Position Sought

Full Time
Part Time
Either

Date Available

Salary Desired

Phone #

Email Address *

Social Security Number

Are you over 18 years old?

Are you legally eligible for employment in the United States?

(If offered employment, you will be required to provide documentation to verify eligibility.)

Have you ever been employed by DPS (Diplomatic Protective Service)?

If so, please state name of location and dates of employment

Education

Please indicate education or training which you believe qualifies you for the position you are seeking.

High School: No. of Yrs Completed

Diploma

G.E.D.

School(s)

City/State

College and/or Vocational School

Number of Years Completed

School(s)

City/State

Major

Degrees Earned

Other Training or Degrees:

School(s)

City/State

Course

Degree or Certificate Earned

Professional License OR Memberships:

Type of License Held

License Number

License Expiration Date

Other Professional Memberships

(You need not disclose membership in professional organizations that may reveal information regarding race, color, creed, sex, religion, national origin, ancestry, age, disability, marital status, veteran status or any other protected status.)

Skills:

Office

Typing
Microsoft Word
Excel
Powerpoint

Other Software Skills

Record Of Conviction:

Have you EVER been arrested?

If yes, explain

During the last seven years, have you ever been convicted of a crime other than minor traffic offense?

If yes, explain

(A conviction will not necessarily automatically disqualify you for employment. Rather, such factors as age and date of conviction, seriousness and nature of the crime, and rehabilitation will be considered).

Employment: Provide Employment history for the last seven years

May we contact your present employer?

If any employment was under a different name, indicate name *

Employer *

Address

Telephone

Position

Dates of Employment (From)

Mo/Yr

Dates of Employment (To)

Mo/Yr

Salary

No. of Hrs.

Supervisor Name *

Supervisor Number

Duties

Reason for Leaving

Employer *

Address

Telephone

Position

Dates of Employment (From)

Mo/Yr

Dates of Employment (To)

Mo/Yr

Salary

No. of Hrs.

Supervisor Name *

Supervisor Number

Duties

Reason for Leaving

Employer *

Address

Telephone

Position

Dates of Employment (From)

Mo/Yr

Dates of Employment (To)

Mo/Yr

Salary

No. of Hrs.

Supervisor Name *

Supervisor Number

Duties

Reason for Leaving

Employment Form

Other Training or Degrees:

Professional License OR Memberships:

Skills:

Record Of Conviction:

Employment: Provide Employment history for the last seven years

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