Application for Independent Contractual Employment

Personal Information
Name (Last, First, Middle)
Present Address	AA AE AK AL AP AR AS AZ CA CO CT DC DE FL GA GU HI IA ID IL IN KS KY LA MA MD ME MI MN MO MP MS MT NC ND NE NH NJ NM NV NY OH OK OR PA PR PW RI SC SD TN TX UT VA VI VT WA WI WV WY
Permanent Address	AA AE AK AL AP AR AS AZ CA CO CT DC DE FL GA GU HI IA ID IL IN KS KY LA MA MD ME MI MN MO MP MS MT NC ND NE NH NJ NM NV NY OH OK OR PA PR PW RI SC SD TN TX UT VA VI VT WA WI WV WY
Phone No
Cell Phone
Fax
Employment Desired: (Investigator/Process Server)
Position
Are you employed?	Yes No
Ever applied to this company before?	Yes No
Education History
Name and Location of School
Years Attended
High School
College
Trade, Business or Correspondence School
General Information
Subjects or Special/ Research Work or Special Training / Skills
License Number (Investigators Only)	State AA AE AK AL AP AR AS AZ CA CO CT DC DE FL GA GU HI IA ID IL IN KS KY LA MA MD ME MI MN MO MP MS MT NC ND NE NH NJ NM NV NY OH OK OR PA PR PW RI SC SD TN TX UT VA VI VT WA WI WV WY
Date of Expiration
Valid License?	Yes No       State AA AE AK AL AP AR AS AZ CA CO CT DC DE FL GA GU HI IA ID IL IN KS KY LA MA MD ME MI MN MO MP MS MT NC ND NE NH NJ NM NV NY OH OK OR PA PR PW RI SC SD TN TX UT VA VI VT WA WI WV WY
Former Employers (List below last four employees, starting with last one first)
Date Month and Year Name & Address of Employer Position Reason For Leaving From To From To From To From To
Reference (Give below the names of three persons not related to you, whom you have known for at least a year.) Name Address Business Years Known
Have you ever been arrested or convicted of a crime in any state? If so, explain:
Have you ever been terminated from a place of employment? If so, explain:
Do you currently have a claim against an employer? If so, explain:
Authorization and Release of Liability I certify that the facts contained in this application are true and complete to the best of my knowledge and understand that, if employed, falsified statements on this application shall be grounds for immediate dismissal. I authorize SJ Investigative Services, LLC its affiliates and representatives to investigate all information in this application or in my resume all statements including: Previous Employers, Driver Records, Credit, Education, State/County Criminal Courthouses and Personal/Professional Associates and any pertinent information they may have, personal or otherwise. I release all concerned from liability in connection with any information they give and any decisions made concerning my employment based on such information. I understand that any offer of employment from SJ Investigative Services, LLC is based upon successful completion of the background investigation. I also understand and agree that no representative of the company has any authority to enter into any agreement for employment for any specified period of time, or to make any agreement contrary to the forgoing, unless it is in writing and signed by an authorized company representative.
* Please note digital signature of full name required to be typed in below.
Yes No
Signature
Date