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Pre-Screening Application

(review privacy policy)

SecurAmerica LLC is an equal opportunity employer. All applicants are considered for employment without regard to race, religion, sex, national origin, color, age, marital or veteran status, the presence of a non-job-related medical condition or physical handicap, or any other status protected by federal or state law.

Please fill out the entire application; be honest and explain answers thoroughly. Upon completing the application click Submit Application. Your application will be e-mailed to our office and our hiring manager will contact you in 3 - 5 business days.

* Your online application will not process until all required fields are completed!

Your Information
First Name * Middle Initial
Last Name *
Address 1 *
Address 2 / Apt. #
City *
State *
Zip Code *
Phone *
E-mail address *
How long at this address? Years Months
If less than 3 years, list full previous address
Dates to
Employment
Date Available to work
Desired Rate of pay
Position desired
Hours Full time Yes No | Part Time Yes No
Are there any days or times of the day or week that you are unable to work?

If yes, please identify:
Yes No

OVER 21 YEARS OF AGE? Yes No
Are you willing to relocate? Yes No
Have you ever been convicted of a crime?

If yes, please describe (a conviction does not necessarily preclude employment with Securamerica):

Yes No

What source referred you to us? Search Engine (i.e. Google, Yahoo, Bing...)
SecurAmerica Employee
Newspaper / Advertising
City or State Employment Agency
Other
Have you ever worked for SecurAmerica?

If Yes, Date of Service and
Position Location

Yes No

Do you have any friends or relatives working for Securamerica?

If so, please list:

Yes No

U.S. Military Service
Service Branch
Final Route or Ratio:
Length of Service:
Area of Specialization:
Employment History
Most Recent Employer
Employer complete address
Phone
Dates Employed (mm / yy)
From to
Position Held / Rate of Pay Postion Rate
Duties
Reason for Leaving
Name of Supervisor
May we contact this employer?

If no, please explain:

Yes No


Previous Employer
Employer complete address
Phone
Dates Employed (mm / yy)
From to
Position Held / Rate of Pay Postion Rate
Duties
Reason for Leaving
Name of Supervisor
May we contact this employer?

If no, please explain:

Yes No


Previous Employer
Employer complete address
Phone
Dates Employed (mm / yy)
From to
Position Held / Rate of Pay Postion Rate
Duties
Reason for Leaving
Name of Supervisor
May we contact this employer?

If no, please explain:

Yes No

Education
Check number of years completed High School 1 2 3 4
High School Name
High School Location
Did you graduate? Yes No
GED, Diploma

Check number of years completed College 1 2 3 4
College Name
College Location
Did you graduate? Yes No
Degree

Other Name
Other Location
Did you graduate? Yes No
Degree
References
List name and telephone number of three business/work references who are not related to you and are not previous supervisors. If not applicable, list three school or personal references who are not related to you.
Name
Title
Relationship to you
Telephone
Number of years known

Name
Title
Relationship to you
Telephone
Number of years known

Name
Title
Relationship to you
Telephone
Number of years known

Language Spoken
Language
Speak: Slight Fair Fluent
Read: Slight Fair Fluent
Write: Slight Fair Fluent

Language
Speak: Slight Fair Fluent
Read: Slight Fair Fluent
Write: Slight Fair Fluent

Language
Speak: Slight Fair Fluent
Read: Slight Fair Fluent
Write: Slight Fair Fluent

SecurAmerica LLC
3399 Peachtree Rd, NE
Suite 1000
Atlanta, GA 30326
Tel: 404.926.4222

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