Application

Are you eligible to work in the United States? *

Are you 18 years of age or older? *

Have you ever been convicted of a crime? *

Do you have any pending charges? *

Please Explain Convictions Here *

Do you have a valid driver’s license? *

Yes No

State Issued *

License Number *

Expiration Date *

ASSIGNMENT AVAILABILITY

High School *

GED *

Other School *

College *

City /State *

City/State *

Did You Graduate? *

Did you Graduate? *

If No # of Years Left to Graduate *

If No # of Years left to Graduate *

Date *

Degree/Major *

SKILLS
Please list technical skills, clerical skills, trade skills, etc., relevant to this position. Include relevant computer systems and software packages of which you have a working knowledge, and note your level of proficiency (basic, intermediate, expert)

WORK EXPERIENCE
Please detail your entire work history. Begin with your current or most recent employer. If you held
multiple positions with the same organization, detail each position separately. Attach additional sheets if necessary. Omission
of prior employment may be considered falsification of information. Please explain any gaps in employment. Include full-time
military or volunteer commitments. PLEASE DO NOT complete this information with the notation “See Resume.”
PLEASE NOTE: Viper Security Services Inc. reserves the right to contact all current and former employers for reference
information.

Employer #1 (Most Current)

REFERENCES: Give the names of Four people that you have known for at least two years

PLEASE READ CAREFULLY AND SIGN THAT YOU UNDERSTAND AND ACCEPT THIS INFORMATION.
I certify that the information on this application and its supporting documents is accurate and complete. I understand and agree that failure to fully complete the form, or misrepresentation or omission of facts, represents grounds for elimination from consideration for sub-contractor services or contract/assignment cancellation, if discovered at a later date. I authorize VIPER Security Services Inc. to investigate, without liability, all statements contained in this application and supporting materials. I authorize references and former employers, without liability, to make full response to any inquiries, in connection with, this application. If requested, I agree to submit to a criminal background investigation and/or screening for illegal substances. I understand that this document is NOT an offer of employment, and that it is not an offer of services or assignments. This does NOTconstitute a contract for continued or guaranteed services/assignments. I understand that staff of Viper Security Services Inc. serve at-will, and the relationship may be terminated at any time by either party, for any or no reason, other than a reason prohibited by law. I will be required to furnish proof of eligibility to work in the United States, and to comply with company and departmental regulations. Must be physically able to walk and work in inclement weather for sometime lengthy periods of time. I understand that, if contracted, it is on a temporary basis. I would be paid for hours worked only, and would be ineligible for benefits including paid time off.