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JOB APPLICATION

EMPLOYMENT APPLICATION

All information entered on this form is considered to be offered as a sworn statement. Any misstatement of fact is reason for disqualification for employment, or may be punishable by law as per N.J.S. 2C:28-2, 2C:28-3 and 2C:28-7.

No person shall be employed by any holder of security agency license until such person to be employed shall have executed and furnished to such license holder the following statement, pursuant to the provisions of “The Security Officer Registration Act (SORA)” as amended by Chapter 134, Laws of 2004.

Full Name

S.S No.

Residence/Address

Home Phone

Cell Phone

Age

Birth Place

Birth Date

S.O.R.A. / Temporary Number

Are you a citizen of the United States?

Yes

If you are not a citizen of the United States, of what country are you a citizen or subject?

Have you ever been convicted of illegally using, carrying, or possessing a pistol or other dangerous weapon?

Yes

Have you been convicted of a crime of the first, second, third or fourth degree?

Yes

Have you ever been indicted for any crime or offense in this State or any other State or Territory?

Yes

Has any security agency license issued to you or to a partnership or corporation of which you were a member or officer, ever been revoked in this State or any other State or Territory because of conviction of any of the crimes or offenses specified in this section?

Yes

Have you ever been convicted of any other crime or offense?

Yes

Has this State or any other State or Territory ever denied any application submitted by you for license as a security officer because of any crime or offenses specified in the preceding questions?

Yes

Reference 1

Reference 2

Reference 3

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Address:

561 Bloomfield Ave. 2nd Flr

Newark, New Jersey 07107

Email: ssiino@pardidetective.com

Phone: 973-483-8000

Hours: Mon-Fri 9am-4pm

Sat 9am-2pm

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