Position Title —Please choose an option—Information Security Engineer (Entry to pre-Intermediate level)Information Security Analyst (Entry Level)
Date Available for Work (mm-dd-yyyy) Wage/Salary Expectations
Last Name First Name Middle Name Date of Birth Other Names Used Social Security Number Current Address Phone Numbers (Home/Phone) Email Address Are you a U.S. Citizen? YesNo If not a U.S. Citizen, do you have permanent U.S. Resident Status? YesNo if yes, provide number:
Note: The Federal Immigration and Reform and Control Act of 1986 requires that a DHS Employment Eligibility Verification “Form I-9” be completed for every new hire, Within 3 business days of beginning work every new hire must present to the employer documentation establishing his/her identity and authorization to work. This federal requirement must be satisfied as a condition of employment.
If hired, are there accommodations we must provide so that you can perform all the essential functions and duties of the position? YesNo if yes, please explain: Are there any days, shifts or hours you cannot work? YesNo if yes, please explain: Are you able to work overtime, if required? YesNo if yes, please explain: When will you be able to start work?
Name of School, City, State and County Date Attended From: To: Graduate? YesNo Degree/Diploma Major Subjects
Name of School, City, State and Country Date Attended From: To: Graduate? YesNo Degree/Diploma Major Subjects
Name of School, City, State and Country Date Attended From: To: Graduate? YesNo
Include all work experience, paid or voluntary. Start with your present or most recent work experience. When describing work, list specific duties/responsibilities and accomplishments. Include supervisory responsibilities and the number of employees supervised. Provide as much detail as possible for work experience that directly relates to the advertised position. Include all periods of unemployment and the reason. (Use additional pages, as needed.)
From To Salary/Wage Hours Per Week Employer's Name and Address Supervisor’s Name and Contact Information May HR contact your supervisor? YesNo Were you a supervisor in this position? YesNo If Yes, How many people did you supervise? Describe your major duties/responsibilities Reasons for Leaving (If you were discharged or forced to resign, please explain)
Include the license or certification number and attach a copy of your current license/certificate if it is a requirement of the position.
Dates of Licensure/Certification State of Issuance Is your License/Certificate Current? YesNo If No, date of Termination/Lapse: Reason for Termination/Lapse: Has your license/certificate ever been suspended and/or revoked? YesNo If Yes, date of suspension/revocation: Please provide details regarding the suspension/revocation:
List skills, formal and online training, and other abilities you consider relevant to the position. List additional languages other than English and the level of fluency/competency for speaking, reading and writing (e.g., basic knowledge, limited knowledge, good working knowledge, fluent, professional translator/interpreter.) List organizations, associations, awards, honors, fellowships, presentations and publications you have authored that you consider significant.
I certify that the answers given herein are true and complete to the best of my knowledge. I understand that any misrepresentations, omissions of facts or incomplete answers in any application document may disqualify me from further consideration for employment. I further understand that, if employed, any misrepresentations or omissions of facts in any application document may be cause for my dismissal at any time without prior notice.
I consent to and authorize Summit Brand Protection to contact my former employers, references, and any and all other persons and organizations for information bearing upon my qualifications for employment. I further authorize the listed employers, schools and personal references to give Summit Brand Protection (without further notice to me) any and all information about my previous employment and education, along with any other pertinent information they may have and hereby waive any actions which I may have against either party(ies) for providing a good faith reference.
I EXPRESSLY AGREE AND UNDERSTAND THAT, IF EMPLOYED, MY EMPLOYMENT IS “AT-WILL”, IS NOT FOR A SPECIFIC TERM, IS BASED ON MUTUAL CONSENT AND MAY BE TERMINATED BY ME OR THE COMPANY WITH OR WITHOUT NOTICE OR CAUSE AT ANY TIME. I FURTHER UNDERSTAND THAT NO ORAL PROMISE, EMPLOYER POLICY, CUSTOM, BUSINESS PRACTICE OR OTHER PROCEDURE (INCLUDING THE BASIC EMPLOYMENT POLICIES, PERSONNEL HANDBOOK OR ANY PERSONNEL MANUALS) CONSTITUTES AN EMPLOYMENT CONTRACT OR MODIFICATION OF THE AT-WILL EMPLOYMENT RELATIONSHIP BETWEEN ME AND SUMMIT BRAND PROTECTION. I ALSO UNDERSTAND THAT THIS ASPECT OF MY EMPLOYMENT WITH SUMMIT BRAND PROTECTION MAY ONLY BE ALTERED WITH A WRITTEN AUTHORIZATION SIGNED BY THE CEO/COO OF SUMMIT BRAND PROTECTION, AND THAT MY AT-WILL STATUS MAY NOT BE ALTERED.
I understand that applicants for certain positions may be required to qualify for employment based upon additional employment criteria. For example, I may be required to provide professional licensure/certification; and/or take a pre-employment drug test. If I am offered employment or start work before any requirement is completed, my employment is contingent upon satisfactory completion and results of all requirements as determined by Management of Summit Brand Protection. I authorize the release of any background check results and of any drug/alcohol test to any governmental state, local or federal authority requesting such information and in response to a valid subpoena or other legal document.
Last Name Email Address
