RATE REGISTRATION FORM

The following is a form for contractual employment with Nordic Security Services. Fill out all the information and submit the application electronically. Please be advised that submitting this form does not guarantee employment with our company. By filling out this form, you will be added to a list of possible candidates for special contractual jobs. All applications will be treated in the strictest of confidence and in accordance with current equal opportunity laws. Thank you for your interest in Nordic Security Services.

First:

*Required

Middle:

Last:

*Required

E-mail:

*Required

Address:

City:

State:

Zip Code:

Phone Number:

*Required

Please answer the following questions:

1. Do you possess any of the following permits?
Check all that apply:

Guard Card
Registration Number:	Expiration Date:
Exposed Firearm
Registration Number:	Expiration Date:
Baton PR-24
Tear Gas / Mace / Pepper
P.O.S.T Certificate:	Expiration Date:

2. Have you ever been convicted of a misdemeanor?

If Yes, Please explain below:

3. Have you ever been convicted of a felony?

If Yes, Please explain below:

Can you, after employment, submit verification of your legal right to work in this country?

Do you have a valid drivers license or State ID?

License Number:
State:

WAIVER AND UNCONDITIONAL RELEASE
( APPLICANT PLEASE READ CAREFULLY )

I agree to comply with all the rules and regulations of this company. I hereby affirm and declare that all foregoing statements are true and correct and that I have not knowingly withheld any fact that would, if disclosed, affect my application unfavorably. I hereby authorize the company to conduct any investigation it deems necessary with respect to information set forth on this application. I also hereby authorize this company to release such information together with their opinions on these matters without any liability for any damage whatsoever caused either directly by giving or receiving such information or opinions. I hereby authorize any former employer, present employer, schools, colleges and universities, utility companies, credit, finance bureau/offices, personal references, and/or other persons to give any information they may have concerning my character, health, credit, and employment record. I hereby unconditionally release any named or unnamed informant from any and all liability resulting from the furnishing of this information.

I understand that nothing herein or otherwise shall be deemed to create any contract of employment between me and the company and that my employment may be terminated by me or the company at any time without advance notice to the other.

In making this application for employment, I also understand that an investigative consumer report may be made whereby information is obtained through personal interviews with my neighbors, friends, or others whom I am acquainted. This inquiry includes information as to my character, general reputation, personal characteristics, and mode of living. I understand that I have the right to make a written request within a reasonable period of time to receive additional, detailed information about the nature and scope of this investigative report.

Nordic Security Services takes a Zero Tolerance approach to drug use on the job. Pre-employment drug screening can take place as well as ongoing random on the job drug screenings while working for Nordic Security Services.

This form is sent over a non-secure connection. If you do not wish to send the form please contact Nordic Security Services at 1-800-883-3880 for an application.

By clicking on this check box I am stating that I have signed this document.

Date Signed:

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