Social Security No.*:
Desired Salary (USD):
Guard Card #:
Guard Card Exp Date:
Firearm Exp Date:
Position Applied for*:
Are you a citizen of the United States? (Yes/No)* -
If no, are you authorized to work in the U.S.? (Yes/No)* -
Have you ever worked for this company? (Yes/No)* -
If yes, when? -
Have you ever been convicted of a felony? (Yes/No) -
If yes, explain:
High School Name:
Did you graduate? (Yes/No) -
Please list three professional references
Starting Salary*: $
Ending Salary*: $
Reason for Leaving*:
May we contact your previous supervisor for a reference? (Yes/No):
Starting Salary: $
Ending Salary: $
Reason for Leaving:
Have you served in the Military? (Yes/No):
If Yes Where you honorably discharged?
Rank at Discharge:
Type of Discharge:
If other than honorable, explain:
Code 4 Private Security Inc. is an equal opportunity/affirmative action employer committed to an inclusive and diverse workplace. All qualified applicants will receive consideration for employment without regards to race, color, religion, sex, sexual orientation, gender identity, national origin, disability status, protected veteran status or any other basis prohibited by law. We also consider qualified applicants with criminal histories consistent with applicable federal, state and local law.
Until further notice, Code 4 Private Security Inc employees working in the United States in any capacity (on a daily or hybrid schedule or as a visitor) are required to provide proof of full vaccination against COVID-19. Employees are considered fully vaccinated two weeks after completion of the entire recommended series of vaccination (usually one or two doses) with a vaccine authorized to prevent COVID-19 by the federal Food and Drug Administration (FDA), including by way of an emergency use authorization. Code 4 Private Security Inc will maintain records associated with your vaccination history in a way that is compliant with all relevant Federal, state and local laws. Exceptions to this requirement are employees who require religious or medical exemption as approved through Code 4 Private Security Inc S accommodations process.
For government reporting purposes, we ask candidates to respond to the below self-identification survey. Completion of the form is entirely voluntary. Whatever your decision, it will not be considered in the hiring process or thereafter. Any information that you do provide will be recorded and maintained in a confidential file.
As set forth in Code 4 Private Security Inc Equal Employment Opportunity policy, we do not discriminate on the basis of any protected group status under any applicable law.
SelectMaleFemaleDecline to Self Identity
Are you Hispanic / Latino
SelectYesNoDecline to Self Identity
Race & Ethnicity (Click Here for Definitions)
SelectYesNoDecline to Self Identity
If you believe you belong to any of the categories of protected veterans listed below, please indicate by making the appropriate selection. As a government contractor subject to the Vietnam Era Veterans Readjustment Assistance Act (VEVRAA), we request this information in order to measure the effectiveness of the outreach and positive recruitment efforts we undertake pursuant to VEVRAA.
A "disabled veteran" is one of the following: a veteran of the U.S. military, ground, naval or air service who is entitled to compensation (or who but for the receipt of military retired pay would be entitled to compensation) under laws administered by the Secretary of Veterans Affairs; or a person who was discharged or released from active duty because of a service-connected disability.
A "recently separated veteran" means any veteran during the three-year period beginning on the date of such veteran's discharge or release from active duty in the U.S. military, ground, naval, or air service.
An "active duty wartime or campaign badge veteran" means a veteran who served on active duty in the U.S. military, ground, naval or air service during a war, or in a campaign or expedition for which a campaign badge has been authorized under the laws administered by the Department of Defense.
An "Armed forces service medal veteran" means a veteran who, while serving on active duty in the U.S. military, ground, naval or air service, participated in a United States military operation for which an Armed Forces service medal was awarded pursuant to Executive Order 12985.
SelectI am not a protected VeteranI dentify as one of more of the classifications of a protected VeteranI don't wish to answer
We are a federal contractor or subcontractor required by law to provide equal employment opportunity to qualified people with disabilities. We are also required to measure our progress toward having at least 7% of our workforce be individuals with disabilities. To do this, we must ask applicants and employees if they have a disability or have ever had a disability. Because a person may become disabled at any time, we ask all of our employees to update their information at least every five years.
Identifying yourself as an individual with a disability is voluntary, and we hope that you will choose to do so. Your answer will be maintained confidentially and not be seen by selecting officials or anyone else involved in making personnel decisions. Completing the form will not negatively impact you in any way, regardless of whether you have self-identified in the past. For more information about this form or the equal employment obligations of federal contractors under Section 503 of the Rehabilitation Act, visit the U.S. Department of Labor’s Office of Federal Contract Compliance Programs (OFCCP) website at www.dol.gov/ofccp
You are considered to have a disability if you have a physical or mental impairment or medical condition that substantially limits a major life activity, or if you have a history or record of such an impairment or medical condition.
Autoimmune disorder, for example, lupus, fibromyalgia, rheumatoid arthritis, or HIV/AIDS
Blind or low vision
Cardiovascular or heart disease
Deaf or hard of hearing
Depression or anxiety
Gastrointestinal disorders, for example, Crohn's Disease, or irritable bowel syndrome
Missing limbs or partially missing limbs
Nervous system condition for example, migraine headaches, Parkinson’s disease, or Multiple sclerosis (MS)
Psychiatric condition, for example, bipolar disorder, schizophrenia, PTSD, or major depression
SelectYes, I have a disability, or have a history / record of having a disabilityNo, I don't have a disability, or a history / record of having a disabilityI don't wish to answer
1 Section 503 of the Rehabilitation Act of 1973, as amended. For more information about this form or the equal employment obligations of Federal contractors, visit the U.S. Department of Labor's Office of Federal Contract Compliance Programs (OFCCP) website at www.dol.gov/ofccp.
PUBLIC BURDEN STATEMENT: According to the Paperwork Reduction Act of 1995 no persons are required to respond to a collection of information unless such collection displays a valid OMB control number. This survey should take about 5 minutes to complete.
Upload ID or Drivers License:
Upload Guard Card:
Upload Social Security Card:
Upload Exposed Firearm Permit:
I certify that my answers are true and complete to the best of my knowledge.
If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release.