The Conley Group, Inc.

NOTICE TO ALL APPLICANTS: Before an employment application is provided to applicants, applicants are required to verify they meet all company qualifications for employment by completing this questionnaire. Failure to complete this questionnaire, or failure to be completely truthful in answering any of the questions below, will result in that applicant not being considered for employment with The Conley Group, Inc.

Prospective applicants will receive consideration without discrimination because of race, color, religion, sex, national origin, age, marital or veteran status, non-job-related medical conditions or handicaps, or any other legally-protected status.

The Conley Group, Inc. Pre-employment Questionaire

Please answer each of the following questions:

1. Are you at least 19 years of age?

yes

2. Do you possess a valid driver's license?

yes

3. Do you have readily available, a licensed and operational vehicle?

yes

4. Do you own an operational telephone?

yes

5. Do you possess a minimum of a High School Diploma or GED?

yes

6. Are you fully physically qualified and emotionally able to successfully perform the job function of a security professional?

yes

7. Have you ever been convicted of a misdemeanor crime (excluding minor traffic violations) or a felony in any country / state?

yes

8. Have you ever been convicted of domestic abuse or any crime that resulted from domestic abuse in any country or state?

yes

9. Do you have a good credit rating?

yes

unknown

10. Will you agree to follow all company rules and regulations?

yes

11. Do you consent to a comprehensive background investigation?

yes

12. Will you work any shift or account that you would be assigned?

yes

13. For full time applicants, are you available to work any days and hours?

yes

14. Are you of good moral character?

yes

15. Do you possess good written and oral communications abilities?

yes

16. Do you use any type of tobacco products?

Yes

17 . Will you be able to successfully operate in a highly structured environment?

yes

18. Are you bound by any legal non-competition or non-disclosure agreement?

yes

19. What is your e-mail?

The Conley Group, Inc. Employment Application

Application Date:

Position applied for:

Name:
Last Middle First

Address:
City/State/Zip:
Telephone: - -

Have you applied for work here before?

yes

If "Yes," give date:

Are you employed now?

yes

May we contact your present employer?

yes

Are you prevented from lawfully becoming employed in this country for any reason?

yes

(Proof of citizen status will be required upon employment)

On what date will you be able to work?

Please select the category that best summarizes your available hours:

Can you travel if the job requires it?

yes

Are you on a lay-off and subject to recall?

yes

Have you ever been convicted of a crime?

yes

If "Yes," please explain

Are you a veteran of the U.S. Military?

yes

If "Yes," specify branch

Was your discharge other than honorable?

yes

If "Yes," please explain:

EDUCATION

High School
School name: Location:
Years Complete:
Graduated?:

yes

Outline specialized training, apprenticeships, internships,
skills, and extracurricular activities:

College/University

School name: Location:
Years Complete: Degree:
Graduated?:

yes

Diploma?

yes

Outline specialized training, apprenticeships, internships,
skills, and extracurricular activities:

Graduate/Professional

School name: Location:
Years Complete: Degree:
Subject of Study:

Outline specialized training, apprenticeships, internships,
skills, and extracurricular activities:

Honors Received: State any additional information you feel may be helpful to us in considering your application.

List professional, trade, business, or civic activities and offices held. (You may exclude memberships that
would reveal sex, race, religion, national origin, age, ancestry, or handicap or other protected status.)

REFERENCES

Please list the name, address, and daytime telephone number of three references who are not related to you and are not previous employers.
Name Address Telephone Number

Reference 1

First Name Last Name
Address
City / State / Zip

Phone: - -

Reference 2

First Name Last Name
Address
City / State / Zip

Phone: - -

Reference 3

First Name Last Name
Address
City / State / Zip

Phone: - -

Briefly summarize special skills and qualifications you have acquired from your employment or other experience.

Do you speak a foreign language?

yes

If so, note below it below and list your ability to read and write in that language.

EMPLOYMENT HISTORY

Employment History for the past ten years (If additional space is needed please email the information to info@theconleygroup.com.) Please give an accurate, complete employment record, filling out all sections. Start with your present or last job. Include military assignments and volunteer activities.

Employer 1

Employer
Telephone - -
Company Address

City / State / Zip:
Job Title
Supervisor's Name
Reason for leaving
Dates Employed From
Date Employed To
Hourly Rate/Salary Starting
Hourly Rate/Salary Final
Work Performed

Employer 2

Employer
Telephone - -
Company Address

City / State / Zip:
Job Title
Supervisor's Name
Reason for leaving
Dates Employed From
Date Employed To
Hourly Rate/Salary Starting
Hourly Rate/Salary Final
Work Performed

Employer 3

Employer
Telephone - -
Company Address

City / State / Zip:
Job Title
Supervisor's Name
Reason for leaving
Dates Employed From
Date Employed To
Hourly Rate/Salary Starting
Hourly Rate/Salary Final
Work Performed

Employer 4

Employer
Telephone - -
Company Address

City / State / Zip:
Job Title
Supervisor's Name
Reason for leaving
Dates Employed From
Date Employed To
Hourly Rate/Salary Starting
Hourly Rate/Salary Final
Work Performed

Signature

The information provided in this Employment Application is true, correct, and complete. If employed, any misstatement or omission of fact on this application may result in my dismissal.

I authorize you to engage a consumer reporting agency to investigate my credit and personal history. If a report is obtained you must provide, at my request, the name and address of the agency so I may obtain from them the nature and substance of the report.

I understand that an offer of employment does not create a contractual obligation upon the employer to continue to employ me in the future.


Date	Signature (type first name then last name)