<p> AAA FIRE SAFETY & ALARM, INC. 334 North Marshall Way, Suite G Layton, UT 84041 TEL (801) 544- 7345 FAX (801) 544- 1411</p><p>APPLICATION AAA Fire Safety and Alarm, Inc. is an equal opportunity employer. All applicants will be considered equally without regard to their race, sex, color, religion, national origin, veteran status, marital status, any disability as provided in the Americans with Disabilities Act, the Age Discrimination in Employment Act, or any other basis protected by the law. Employment may be terminated by either party at any time, with or without cause.</p><p>Date ____/____/____</p><p>Name: ______</p><p>Complete Address ______</p><p>Date of Birth___/___/___ Home Phone :(____) ______Work Phone: (____) ______</p><p>Position applied for ______Salary desired ______</p><p>[ ] Full-time [ ] Part-time [ ] Temp or Summer employment </p><p>Date available to start ____/____/____</p><p>Have you ever applied or worked at AAA Fire before? Yes [ ] No [ ]</p><p>If Yes, state when you applied and/or worked. ______</p><p>How did you learn of our company and/or position? ______</p><p>Are you over 18? Yes [ ] No [ ]</p><p>Are you a citizen of the U.S or do you have the legal right to be employed in the U.S? Yes [ ] No [ ]</p><p>Can you perform the essential functions of the job, with or without reasonable accommodation? Yes [ ] No [ ]</p><p>Have you ever been convicted of a felony? Yes [ ] No[ ] (Conviction will not necessarily disqualify an applicant for employment).</p><p>If yes, describe conditions: ______</p><p>MILITARY SERVICE: Have you ever served in the military? Yes [ ] No [ ] Branch ______Final Rank ______</p><p>EDUCATION: Name & Location Course of Study High School Graduate? Yes [ ] No [ ]</p><p>College/University Diploma:</p><p>Graduate? Yes [ ] No [ ]</p><p>Trade School or Graduate School Diploma:</p><p>Graduate? Yes [ ] No [ ]</p><p>List any scholastic honors, offices held and activities involved in during high school or college (you may exclude any that would disclose membership in a protected class): ______</p><p>List and describe any other school or specialized training relevant to the position applied for______</p><p>WORK HISTORY: If currently employed, may we contact your present employer? Yes [ ] No [ ]</p><p>Have you ever been fired or asked to resign from a job? Yes [ ] No [ ] If yes, explain______</p><p>If you worked in any of your previous positions under another name, please give the name(s)______</p><p>List employers with present or last employer first. Account for all periods of time including any volunteer service or periods of unemployment. If self-employed, give firm name and supply business references.</p><p>Name of employer Name of employer ______Address Address ______Street City State Zip Street City State Zip</p><p>From:___/___ To:___/___ Job Title:______From:___/___ To:___/___ Job Title:______</p><p>Beginning wage:______Ending:______Beginning wage:______Ending:______</p><p>Name & Title of last supervisor:______Name & Title of last supervisor:______Phone:______Phone:______</p><p>Reason for leaving:______Reason for leaving:______Name of employer Name of employer ______Address Address ______Street City State Zip Street City State Zip</p><p>From:___/___ To:___/___ Job Title:______From:___/___ To:___/___ Job Title:______</p><p>Beginning wage:______Ending:______Beginning wage:______Ending:______</p><p>Name & Title of last supervisor:______Name & Title of last supervisor:______Phone:______Phone:______</p><p>Reason for leaving:______Reason for leaving:______</p><p>REFERENCES Please give three references who are not relatives.</p><p>______Name Address Phone# Occupation</p><p>______Name Address Phone# Occupation</p><p>______Name Address Phone# Occupation</p><p>AFFIDAVIT I certify that my answers to the foregoing questions are true and correct without misrepresentation and/or omissions of any kind. I understand that if employed, any false, misleading or incorrect statements made on this application or during any interviews may be grounds for my immediate discharge. I hereby authorize the AAA Fire Safety and Alarm, Inc. to contact any company or individual it deems appropriate to investigate my employment history, character, and qualifications. I give my consent to their revealing and all information as a result of this investigation.</p><p>Signature ______Date ____/____/____</p>