I.  GENERAL INFORMATION

Date:

January February March April May June July August September October November December 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 2007 2008 2009 2010 2011 2012

Last Name:

First Name:

Street Address:

City/State/Zip:

Home Phone (with area code):

Cellular Phone (with area code):

Date of Birth:

Drivers License State:

Drivers License Number:

Are you over the age of 18?  Yes No

Have you ever worked for Trinity Executive Services, Inc. or Trinity Security, Inc. Yes No

If yes to question above, when?

Have you ever been convicted of a misdemeanor or felony crime?  Yes No

If yes to question above, please explain below.

(An answer of yes does not necessarily disqualify you from employment)

II. JOB RELATED INFORMATION

Position applying for:  Armed Security Officer Unarmed Security Officer Loss Prevention Traffic Control Officer Investigator

Salary Requirements (hourly):

Full-time or Part-time? Full Time Part Time

List days not available to work:

III. MILITARY SERVICE

I am prior military: Yes No   Branch of Service: USMC Army Navy Air Force National Guard Other None

From (MM/DD/YY):   To (MM/DD/YY):

Discharge Status: Honorable Other than Honorable Dishonorable Other Does not Apply

IV.  EDUCATION

I have a high school diploma or GED? Yes No

I have completed some college? Yes No

I have a college degree? Yes No

V. EMPLOYMENT HISTORY

Please list your last three employers, including part-time and self-employment.  May we contact your present employer at this time? Yes No

Employer:

Street Address:

City/State/Zip:

Responsibilities:

Employed From:

Employed To:

Salary:

Reason for Leaving:

Employer:

Street Address:

City/State/Zip:

Responsibilities:

Employed From:

Employed To:

Salary:

Reason for Leaving:

Employer:

Street Address:

City/State/Zip:

Responsibilities:

Employed From:

Employed To:

Salary:

Reason for Leaving:

RELEASE AND ACKNOWLEDGEMENT

PLEASE READ CAREFULLY BEFORE SIGNING

I understand and agree that if I am employed, I shall be employed on an at-will basis.  As an at-will employee, I understand that both the company and I can terminate our employment relationship at any time with or without advance notice and with or without cause.  I further understand that, although over the course of my employment other terms and conditions of my employment may change, the at-will term of my employment will not change.

I understand that Trinity Executive Services, Inc. may choose to conduct pre- and post-employment drug testing without additional consent.  In the event that I am employed, I understand that I must comply with all company policies and rules.

I give the employer the right to investigate all references and to secure additional information about me, if job related.  I hereby release the employer and its representatives from liability for seeking such information and all other persons, corporations or organizations from furnishing such information.

I understand that any offer of employment is conditioned upon acceptable references and satisfactory completion of the verification process in accordance with the Immigration Reform and Control Act of 1986 (I-9) which requires that I provide satisfactory evidence of my identity and legal right to work in this country.  In the event that I become employed by Trinity Executive Services, Inc., I represent that my employment will not result in the breach of employment of confidentiality agreements, if any, with my prior employers.

By choosing below that I agree, I certify and acknowledge that I have read the above, agree and understand it.  I further understand that any omission, misrepresentation, misleading answer, concealment or failure to answer fully, completely and accurately will be grounds for my disqualification from consideration for employment or for terminating my employment with the Company.

I AGREE WITH THE RELEASE AND ACKNOWLEDGEMENT  I Agree I Disagree