Security Application

Your Information

Name

First Middle Last

Sex

Female
Male

Address

Street Address City State / Province / Region ZIP / Postal Code

Phone*

Driver's License Number

State License Number Was Issued

Student Email Address

Student Classification

First Year
Second Year

Course of Study

Do you have a workstudy grant from the Financial Aid department?

Yes
No

What is your cumulative grade point average?

Minimum GPA of 2.25 required

CPR certification?

Yes
No

If CPR certified, what is the expiration?

First Aid?

Yes
No

If First Aid certified, what is the expiration?

Computer Experience

Past Work Experience

Company #1

Please include: Company Name, City, State, Zip, Supervisor Name, Phone

Company #2

Please include: Company Name, Street Address, City, State, Zip, Supervisor Name, Phone

References

Reference #1

Please include: Name, Street Address, City, State, Zip, Phone

Reference #2

Please include: Name, Street Address, City, State, Zip, Phone

Reference #3

Please include: Name, Street Address, City, State, Zip, Phone

Do you have any current health conditions, that you are aware of, that could prevent you from completing the duties of a Safety and Security Officer?

Yes
No

Have you had any driving violations within the last five (5) years?

Yes
No

If yes, state violation(s) and date(s):

During the past five years have you been arrested or served a sentence in jail or prison or been convicted of a misdemeanor or felony for which a jail sentence could have been imposed? You may answer “no” if the conviction or criminal records have been annulled, sealed, set aside or purged, or if you have been pardoned pursuant to law.

Yes
No

If yes, please explain

Information concerning this question will not be used to automatically bar you from employment but may be used to direct your interest to areas less relating to the area of your conviction.

Please write a short essay about why you would like to work for the Safety and Security Department.

I understand that before I can be employed by the Safety and Security Department, I must (1) get a driver’s license check done by any county administrator and submit it to the Director of Safety and Security and (2) allow the Safety and Security Department to contact my references regarding my application. I understand that by signing this application for employment is factual to the best of my knowledge and that any false answer, statement or non-compliance made by me in this application or other required documents will result in denial of employment or termination of employment.

Name of Applicant

Date

Central Lakes College is an affirmative action/equal opportunity educator and employer. Upon request this document will be made available in large print or audio tape. TTY: (218) 855-8224 Brainerd, Minnesota

Security Application

Central Lakes College Safety and Security Department Application for Student Employment

Your Information

Past Work Experience

References