Pre-Screening Questionnaire Please complete this form for the Security Officer position with Inline Defense, LLC.**BY COMPLETING THIS QUESTIONNAIRE, YOU ARE CERTIFYING THAT YOU ARE 21 YEARS OF AGE OR OLDER** Name* First Last Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarrussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRéunionRomaniaRussiaRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUS Minor Outlying IslandsUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe Country Phone Number*Email* Preferred Method(s) of Contact (check all that apply) Phone Call Text Email What is your desired hourly rate for this position?Dollars*Cents*EXPERIENCE & QUALIFICATIONSDo you have military experience? If so, provide details such as years of experience, occupational specialties, etc.*Do you have law enforcement experience? If so, provide details such as years of experience, department, location, special skills, etc.*Do you have security experience? If so, provide details such as years of experience, employer(s), location(s), special skills, etc.*Do you have any active certifications with the Private Protective Services Board (PPSB)? If so, please (a) specify if you are currently Unarmed and/or Armed certified with the PPSB, (b) provide the expiration date on your PPSB Unarmed/Armed registration card, (c) state who provided the training?*Do you consider yourself to be physically fit with the ability to constantly stand on your feet, and maintain mental focus and awareness of your surroundings during assigned shifts?*YesNoThis position requires a favorable background investigation with both local and state law enforcement agencies. Is there anything in your personal history that would prevent you from obtaining a favorable background check?*AVAILABILITYDate* What is your typical availability to work each week? If you are currently employed, do you intend to replace or supplement your current work hours?*If hired and you do not already possess a PPSB certification, two days of Unarmed and/or three days of Armed training and certification (8:00 am - 5:00 pm) are required. Would you be able to devote this amount of time for training? (The location is near the intersection of Creedmoor Road and Strickland Road in Raleigh.)*YesNoYour responses to the next four questions will help us determine if we will have to factor in additional time before work start date, if hired, to order any uniform items not currently on hand. Please provide your sizes for each of the following:DRESS SHIRTT-SHIRTTROUSERSBOOTSHow did you hear about us (ie Facebook, Craigslist, friend, family member, etc.)?*RESUME UPLOADA description of the section goes here.Please upload your resume in either .doc or .pdf format only. This iframe contains the logic required to handle Ajax powered Gravity Forms. Employment Application APPLICANT INFORMATIONName First Middle Last Date: Address Street Address Apartment/Unit # City State / Province / Region ZIP / Postal Code PhoneEmail Date Available:Social Security No.:Desired Salary: $Position Applied for:Are you a citizen of the United States?YesNoIf no, are you authorized to work in the U.S.?YesNoHave you ever worked for this company?YesNoIf yes, when?Have you ever been convicted of a felony?YesNoIf yes, explain:EDUCATIONHigh School:Address:From:To:Did you graduate?YesNoDiploma::College:Address:From:To:Did you graduate?YesNoDegree:Other:Address:From:To:Did you graduate?YesNoDegree:REFERENCESFull Name:Relationship:Company:Phone:Address:Full Name:Relationship:Company:Phone:Address:Full Name:Relationship:Company:Phone:Address:PREVIOUS EMPLOYMENTCompany:Phone:Address:Supervisor:Job Title:Starting Salary: $Ending Salary: $Responsibilities:From:To:Reason for Leaving:May we contact your previous supervisor for a reference?YesNoCompany:Phone:Address:Supervisor:Job Title:Starting Salary: $Ending Salary: $Responsibilities:From:To:Reason for Leaving:May we contact your previous supervisor for a reference?YesNoCompany:Phone:Address:Supervisor:Job Title:Starting Salary: $Ending Salary: $Responsibilities:From:To:Reason for Leaving:May we contact your previous supervisor for a reference?YesNoMILITARY SERVICEBranch:From:To:Rank at Discharge:Type of Discharge:If other than honorable, explain:DISCLAIMERI certify that my answers are true and complete to the best of my knowledge. If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release.Date: This iframe contains the logic required to handle Ajax powered Gravity Forms. Availability Name:*Date: Sunday:Monday:Tuesday:Wednesday:Thursday:Friday:Saturday:I certify that the information provided above in regards to my hours of availability is true and complete to the best of my knowledge and that I do not anticipate significant variations from the information provided above.Date: This iframe contains the logic required to handle Ajax powered Gravity Forms.