Application

*ALL FIELDS IN RED ARE REQUIRED

POSITION APPLIED FOR: 

Off-Duty Law Enforcement Retired Law Enforcement Security Officer Supervisor/Manager Administrative Staff

APPLICATION DATE: 

3/10/2010

DESIRED PAY: 

REFERRED BY: 

Career Builder Jobfox WorkBaltimore.com Employment Guide Baltimore Sun Paper Washington Post Local Community Paper CraigsList Google Yahoo MSN AOL Other Website Employment Agency Blueguard Employee Blueguard Client

Personal Info

NAME:  (Last | First | Middle | Suffix)

DRIVER LICENSE# 

LICENSE STATE:

PRIMARY TRANSPORTATION:

MARITAL STATUS: 

Undisclosed Single Married Separated Divorced Widow/Widower

GENDER: 

Male Female

 RACE:

DATE OF BIRTH:

SS# 

Contact Info

HOME PHONE: 

CELL PHONE: 

WORK PHONE: 

PAGER: 

PRIMARY EMAIL ADDRESS: 

Address Info

(Number | Direction | Street Name | Suffix)

E N NE NW S SE SW W ALY ANX AVE BLVD BND BR BRG CIR COR CP CPE CRSE CSWY CT CTR CURV CV DR DV EXPY EXT FLD FLT FLTS FT FWY GDN GR GRV HBR HL HOLW HTS HWY INLT IS ISLE JCT KNL LN LNDG LOOP MALL ML MNR MTWY ORCH PARK PATH PIKE PKWY PL PLZ PT RD RNCH RPD RTE SMT SQ ST STA TER TPKE TRAK TRL TRWY VIA VLY VW WALK WAY XING

(City | State | Zip Code)

(Unit Type | Unit Number)

APT BLDG BSMT DEPT FL FRNT HNGR LBBY LOT LOWR OFC PH PIER REAR RM SIDE SLIP SPC STE STOP TRLR UNIT UPPR

Law Enforcement Info

For current or retired law enforcement, include the following information:

AGENCY NAME: 

RANK# 

Agent Cadet Captain Chief Colonel Corporal Deputy Deputy 1st Class Detective Detective 1st Class First Sergeant Inspector Lance Corporal Lieutenant Lt Colonel Major Marshall Officer Officer 1st Class OTHER Police Agent Sergeant Sergeant 1st Class Sergeant Major Sheriff Trooper Trooper 1st Class

DEPT ID# 

MPTC# 

Security Certification Info

For CSO applicants already certified with an agency in Maryland, include the following information:

Previous Security Agency: 

Position: 

Certification# 

Certification Expires: 

Employment History

List your three most current employers, starting with the most recent:

EMPLOYER NAME: 

POSITION: 

PHONE: 

START&END DATES: 

REASON FOR LEAVING: 

EMPLOYER NAME: 

POSITION: 

PHONE: 

START&END DATES: 

REASON FOR LEAVING: 

EMPLOYER NAME: 

POSITION: 

PHONE: 

START&END DATES: 

REASON FOR LEAVING: 

Education Info

Indicate your high school and college education information below:

HIGH SCHOOL ATTENDED: 

START&END DATES: 

GRADUATED: 

YES  

G.E.D.: 

YES

COLLEGE ATTENDED: 

START&END DATES: 

CREDITS: 

FIELD: 

GRADUATED: 

YES  

DEGREE: 

Associates Bachelors Masters Doctorate Other

COLLEGE ATTENDED: 

START&END DATES: 

CREDITS: 

FIELD: 

GRADUATED: 

YES  

DEGREE: 

Associates Bachelors Masters Doctorate Other

Criminal History

If you have ever been charges with a crime or serious traffic violation, please list it below:

CHARGE: 

STATE: 

DATE: 

JUDICIAL DISPOSITION: 

CHARGE: 

STATE: 

DATE: 

JUDICIAL DISPOSITION: 

CHARGE: 

STATE: 

DATE: 

JUDICIAL DISPOSITION: 

References

Provide 3 professional references that are not relatives and do not live with you:

NAME: 

ADDRESS: 

PHONE: 

KNOWN YOU FOR HOW LONG: 

NAME: 

ADDRESS: 

PHONE: 

KNOWN YOU FOR HOW LONG: 

NAME: 

ADDRESS: 

PHONE: 

KNOWN YOU FOR HOW LONG: 

About You

Tell us about yourself, you previous experience, your reason for application, and anything else you believe to be pertinent to this application: 

Application Agreement

Please read the terms & conditions of this Application Agreement. You must accept this agreement to submit your Application for Employment. 

I agree to the above Application Agreement terms & Conditions.