a test Employment Details Employment Data FormName* First Middle Last Address* Street Address City State / Province / Region ZIP / Postal Code Home PhoneCell PhoneEmail* Social Security Number*Date of Birth* Officer AvailabilityAvailability (Check all that apply)* Full Time Part Time Special Events Only Day Availability (Check all that apply)* All Days Some Days Weekends (Friday to Sunday) Days Monday Tuesday Wednesday Thursday Friday Saturday Sunday Shift Availability* All Shifts Some Shifts Shifts Morning Afternoon Overnight Type of Employee*Security OfficerActive Law EnforcementRetired Law EnforcementLaw Enforcement Type* Court Officer Police Officer Corrections Officer Peace Officer Retirement Date*Month123456789101112Day12345678910111213141516171819202122232425262728293031Year2019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920ID Headshot (No hats or sunglasses)*Resume*Copy of Guard Card*Drivers License or Government ID Card*Employee's Statement Under penalties of perjury, I hereby affirm that I am either a citizen of the United States of America or an alien lawfully admitted for permanent residence in the United States. I hereby consent to a complete background check being performed, including but not limited to a credit check and criminal convictions history search. Further, I understand that the results of that background check may be a factor in my being hired.Signature*By typing your name you are giving your digital signature that you agree to the terms and conditions above.Date*Month123456789101112Day12345678910111213141516171819202122232425262728293031Year2019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Online Phone Employee Screening Instructions These instructions show you how to complete our online employee screening process. You must complete the survey, print out the instruction document found below, enter the reference number, and return it to to us. You can return it by: Scanning and emailing it to [email protected] Faxing it to (212) 808-4655 Mailing it to: Integrated Security Services, 305 Madison Avenue, Suite 2137, New York, NY 10165 Hand delivering it to our offices. The survey can be found here. Click here to download the instructions.CertificationsGuard Type*ArmedUnarmedUnarmed 8hr Certificate*YesNoExpiration Date:*Month123456789101112Day12345678910111213141516171819202122232425262728293031Year2019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Armed 8hr Certificate:YesNoRenewal Date:*Month123456789101112Day12345678910111213141516171819202122232425262728293031Year201920182017201620152014201320122011201020092008200720062005200420032002200120001999199819971996199519941993199219911990198919881987198619851984198319821981198019791978197719761975197419731972197119701969196819671966196519641963196219611960195919581957195619551954195319521951195019491948194719461945194419431942194119401939193819371936193519341933193219311930192919281927192619251924192319221921192047hr Armed Certificate:*YesNoDate Issued*Month123456789101112Day12345678910111213141516171819202122232425262728293031Year201920182017201620152014201320122011201020092008200720062005200420032002200120001999199819971996199519941993199219911990198919881987198619851984198319821981198019791978197719761975197419731972197119701969196819671966196519641963196219611960195919581957195619551954195319521951195019491948194719461945194419431942194119401939193819371936193519341933193219311930192919281927192619251924192319221921192016hr Certificate:*YesNoDate Issued*Month123456789101112Day12345678910111213141516171819202122232425262728293031Year2019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Fire Guard*YesNoExpiration Date:*Month123456789101112Day12345678910111213141516171819202122232425262728293031Year2019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920CPR:*YesNoExpiration Date:*Month123456789101112Day12345678910111213141516171819202122232425262728293031Year2019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Fire Safety Director:*YesNoExpiration Date:*Month123456789101112Day12345678910111213141516171819202122232425262728293031Year2019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920On-site Test Date:*Month123456789101112Day12345678910111213141516171819202122232425262728293031Year2019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Substance Abuse PolicyPursuant to my employment with Secur Corp. (DBA Integrated Security Services, Inc., further known as the "Company"), I hereby authorize and give full permission to the Company and/or their third party screening company, physician or laboratory to send a specimen of my urine, hair and/or blood to a laboratory to test for the presence of illegal drugs and controlled substances taken in a manner not consistent with prescription use. I understand that the Company will use the results of such tests to make employment-related decisions regarding my employment with them or client customers, and I will release and hold harmless the Company, its owners, affiliates, management and its client customers and the testing facility and/or lab from any claims, charges or causes of action related to this testing and/or use of its results. I authorize the company to release drug and/or alcohol test results to any state or federal agencies, client companies, the Medical Review officer, and any of the Company's insurance carriers. I release and hold harmless the Company for any action(s) that may result from this release. I understand this policy and authorization. I have been informed that any questions I may have about the drug and/or alcohol test will be answered. IN ACCORDANCE WITH THE POLICY OF THE COMPANY, AND THIS AUTHORIZATION AND CONSENT, I UNDERSTAND THE COMPANY WILL REQUIRE A DRUG TEST WHENEVER AN ON-THE-JOB ACCIDENT OR INJURY IS REPORTED, AND IN ACCORDANCE WITH STATE LAW SUBSTANCE ABUSE POLICY The company is dedicated to maintaining a drug-free environment for our clients and employees. The company is committed to only hiring employees of good character, and we consider the use of illegal drugs to be criminal activity. To that end, the following substance policy is in effect for all current and future employees of the Company THIS POLICY EXPRESSLY PROHIBITS The use, possession, solicitation, sale or manufacture of illegal drugs, controlled substances, alcohol and/or prescription medication used in a manner inconsistent with the prescription while on company or customer premises or while performing company business. being impaired or under the influence of legal or illegal drugs or alcohol on company or customer premises or while performing company functions. Wehn an employee experiences side effects from prescribed medication that may impair his/her ability to perform his/her job safely and properly, it is the respponisbility of the employee to notify the Company. For the purpose of this policy, testing positive on a drug test or testing 0.04 bac (Blood Alcohol Content) or higher on an alcohol test will be considered prima facie proof of "being impaired or under the influence". A felony charge for possession, use, solicitation for or the sale of legal or illegal drugs, alcohol or prescription drugs must be reported to the Company's management. Aforementioned charges will subject the employee to disciplinary action up to and including discharge. ANY EMPLOYEE VIOLATING ANY OF THE ABOVE IS SUBJECT TO DISCIPLINARY ACTION UP TO AND INCLUDING DISCHARGE FOR THE FIRST OFFENSE THE COMPANY WILL TEST FOR THE FOLLOWING: WORKPLACE ACCIDENTS/INCIDENTS--Any employee of the Company will be required to submit to a drug test if he or she is involved in a work place incident, which results in injury or illness to the employee or any other person, or in instances of property damage estimated to be $500 or more. All employees of the Company have an obligation to report any workplace injury, regardless of how minor they appear. If either the employee or the Company determines that medical attention/care is necessary, then the employee will be required to undergo a post-accident drug test. In accordance with appropriate Workers' Compensation Laws in states within which we operate, insurance coverage for the injury may be denied if the results of such tests are positive for illegal drugs, alcohol, and/or illegally used prescription medications. EMPLOYMENT DECISIONS--Applicants/Employees of the Company may be required to take a drug test in order to be eligible for certain job assignments or to be eligible for continuing and assignment (periodic announced) with a client. Any applicant who refuses to submit to a pre-employment drug screening will be deemed ineligible for Hire with the Company. Failure of the employee to pass a drug test will result in termination from the Company. Any Integrated Security Employee or applicant who refuses to submit to a drug and/or alcohol test under the terms of this policy will be terminated or denied employment. RANDOM SELECTION-- The Company reserves the right to randomly select employees for testing based on certain safety-sensitive posiitons. Prior to initiating random selection testing, the Company will announce the terms and conditions to the affected group and/or groups of employees. FOR CAUSE/REASONABLE SUSPICION-- When an employee exhibits behavior which is consistent with the contemporaneous phyiscal evidence of impairment, drug and/or alcohol testing may be utilized. The evidence will be documented, and the employee will be removed from the job site pending the results of the aforementioned tests. Results of all drug and/or alcohol tests will be treated confidentially within the scope of what is outlined in the Authorization and Consent form. Employees of the Company who test positive or come forward with a substance and/or alcohol-related problem may request referral to local public agencies that provide rehabilitation and counseling services. The financial obligation of these aforementioned services will remain the responsibility of the employee, and not hte Company, except within normal coverage under an existing insurance plan. I have read and understand the substance abuse policy of the Company. If employed by the Company, I will abide by this policy.Signature*By typing your name you are giving your digital signature that you agree to the terms and conditions above.Date*Month123456789101112Day12345678910111213141516171819202122232425262728293031Year2019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Non-Disclosure AgreementNondisclosure Agreement between Integrated Security Services, Inc., [ISS] and Undersigned Employee: This Nondisclosure Agreement (the "Agreement") is entered into by and between Integrated Security Services, Inc., its principal offices at 305 Madison Avenue, Suite 2137, New York, NY 10165 ("Disclosing Party") and Undersigned Employee for the purpose of preventing the unauthorized disclosure of Confidential Information as defined below. The parties agree to enter into a confidential relationship with respect to the disclosure of certain proprietary and confidential information ("Confidential Information"). Definition of Confidential Information. For purposes of this Agreement, "Confidential Information" shall include all information or material that has or could have commercial value or other utility in the business in which Disclosing Party is engaged. If Confidential Information is in written form, the Disclosing Party shall label or stamp the materials with the word "Confidential" or some similar warning. If Confidential Information is transmitted orally, the Disclosing Party shall promptly provide a writing indicating that such oral communication constituted Confidential Information. Exclusions from Confidential Information. Receiving Party's obligations under this Agreement do not extend to information that is: (a) publicly known at the time of disclosure or subsequently becomes publicly known through no fault of the Receiving Party; (b) discovered or created by the Receiving Party before disclosure by Disclosing Party; (c) learned by the Receiving Party through legitimate means other than from the Disclosing Party or Disclosing Party's representatives; or (d) is disclosed by Receiving Party with Disclosing Party's prior written approval. Obligations of Receiving Party. Receiving Party shall hold and maintain the Confidential Information in strictest confidence for the sole and exclusive benefit of the Disclosing Party. Receiving Party shall carefully restrict access to Confidential Information to employees, contractors and third parties as is reasonably required and shall require those persons to sign nondisclosure restrictions at least as protective as those in this Agreement. Receiving Party shall not, without prior written approval of Disclosing Party, use for Receiving Party's own benefit, publish, copy, or otherwise disclose to others, or permit the use by others for their benefit or to the detriment of Disclosing Party, any Confidential Information. Receiving Party shall return to Disclosing Party any and all records, notes, and other written, printed, or tangible materials in its possession pertaining to Confidential Information immediately if Disclosing Party requests it in writing. Time Periods. The nondisclosure provisions of this Agreement shall survive the termination of this Agreement and Receiving Party's duty to hold Confidential Information in confidence shall remain in effect until the Confidential Information no longer qualifies as a trade secret or until Disclosing Party sends Receiving Party written notice releasing Receiving Party from this Agreement, whichever occurs first. Relationships. Nothing contained in this Agreement shall be deemed to constitute either party a partner, joint venturer of the other party for any purpose. 6. Severability. If a court finds any provision of this Agreement invalid or unenforceable, the remainder of this Agreement shall be interpreted so as best to effect the intent of the parties. Integration. This Agreement expresses the complete understanding of the parties with respect to the subject matter and supersedes all prior proposals, agreements, representations and understandings. This Agreement may not be amended except in a writing signed by both parties. 8. Waiver. The failure to exercise any right provided in this Agreement shall not be a waiver of prior or subsequent rights. Signed on behalf of: Integrated Security Services, Inc. Employee Name:*Date*Month123456789101112Day12345678910111213141516171819202122232425262728293031Year2019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Government FormsPlease print and fill out these forms. These forms must be signed by you and returned to our office. IRS W-4 New York State IT-2104 New Jersey W-4 Connecticut W-4 New York Security Guard Application Mandatory Training MemosPlease download and read all memos and print and fill out the "Post Employee Hiring Training Receipt". This form must be signed by you and returned to our office. Use of Force Use of Force Part 2 Active Shooter Events Preparing an Incident Report Responding to Domsetic Violence Calls Basic Fire Safety Procedures Post Employee Hiring Training Receipt Uniform EquipmentUniform Equipment Owned (Check all that apply) Business Attire Cargo Pants Flashlight Basic MeasurementsShirt, Sweatshirt & Windbreaker SizeX SmallSmallMediumLargeX-LargeXX-LargeOtherHeightWeightSleeve LengthCollarMens/Womens Jacket MeasurementChestSleeve LengthPant MeasurementWaistInseamFOR OFFICE USE ONLYTransaction NumberGuard UID NumberDate MM DD YYYY Drug Test This iframe contains the logic required to handle Ajax powered Gravity Forms.