Application

The Conley Group, Inc.

Security Division Pre-employment Questionnaire

To the applicant: Before a full employment application is given out to an applicant, that applicant is required to verify that they meet all company qualifications for employment by completing this questionnaire. Failure to complete this questionnaire, or failure to be truthful in answering the questions below, will result in that applicant not being considered for employment with The Conley Group, Inc.

Please answer each of the following questions:

Are you at least 19 years of age? Yes No
Do you possess a valid driver's license? Yes No
Do you have readily available, a licensed and operational vehicle? Yes No
Do you have an operational telephone at your place of residence? Yes No
Do you possess a minimum of a High School Diploma or GED? Yes No
Are you physically and emotionally able to successfully perform the job function of a security officer? Yes No
Have you ever been convicted of a serious misdemeanor crime or a more serious crime in any state? Yes No
Do you have a good credit rating? Yes No
Will you agree to follow to all company rules and regulations? Yes No
Do you consent to a comprehensive background check? Yes No
Will you work any shift or account that you would be assigned? Yes No
For full time applicants, are you available to work any days and hours? Yes No
Are you of good moral character? Yes No
Do you possess good written and oral communications abilities? Yes No
Do you use any type of tobacco product? Yes No (If yes, please complete the following statement)
Will you be able to successfully operate in a highly structured environment?
Yes No

I have completed this questionnaire honestly and completely. I understand that my omitting or falsifying any information herein will constitute grounds for not being selected for employment or being retained in an employment status if such information is discovered after I am employed.

Applicant's Name Date

EMPLOYMENT APPLICATION

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.

Date of Application

Position applied for:

Name (Last, First Middle):

Address

City

State

Zip

Telephone (include area code)

Please check response

Are you at least 19 years old? Yes No

Have you applied for work here before? Yes No

If "Yes," give date

Are you employed now? Yes No

May we contact your present employer? Yes No

Are you prevented from lawfully becoming employed in this country because of Visa or Immigration Status? (Proof of citizen status will be required upon employment)
Yes No

On what date will you be able to work?

Please check the category that best summarizes your available hours
Full-time Part-time Shift work Temporary

Can you travel if the job requires it? Yes No

Are you on a lay-off and subject to recall? Yes No

Have you ever been convicted of a crime? Yes No

If "Yes," please explain

Are you a veteran of the U.S. Military? Yes No

If "Yes," specify branch

Was your discharge other than honorable? Yes No

If "Yes," please explain

	High School	College/University	Graduate/Professional
School name, location
Years Completed/Degree
Diploma/Degree
Describe course 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.)

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

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

Do you speak a foreign language? 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
Telephone
Company Address
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
Telephone
Company Address
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
Telephone
Company Address
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
Telephone
Company Address
Job Title
Supervisor's Name
Reason for leaving
Dates Employed From
Date Employed To
Hourly Rate/Salary Starting
Hourly Rate/Salary Final
Work Performed

In reference to your "yes" answer to Question #15 regarding your use of any type of tobacco product, please read the following and then sign below in the appropriate place.

The Conley Group, Inc's policies regarding the use of any type of tobacco product by employees is as follows:

The Conley Group General Order #14

Smoking or chewing tobacco of any kind is strictly prohibited while in uniform either on or off duty, or when on duty without a uniform with no exceptions. Failure to comply will result in disciplinary action up to and including termination.

The Conley Group Smoking and Use of Tobacco Policy

Employees in uniform or under pay are not allowed to smoke or use tobacco products. Violation of this rule will result in disciplinary action, up to and including discharge. This rule also includes an employee who may be commuting to or from work in uniform and who is not under pay.

You should know that it is, and will continue to be, our policy and practice of terminating anyone who violates these policies. Our policies, including the above mentioned policy, are largely driven by customer requirements and are not personal value judgments about anyone who may use tobacco products.

I have read and understand the above information regarding The Conley Group, Inc.'s policies in reference to the use of tobacco products and hereby declare the following:

If employed at The Conley Group, Inc. (check one):

I Can and will follow Yes The Conley Group, Inc.'s tobacco policies.

I Cannot or will not follow Yes The Conley Group, Inc.'s tobacco policies.

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