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First Name Last Name
Street Apt#
City State Zip Code

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Shift Desired Hourly Pay Desired Florida Security License Number:

What type of security license do you have?  D G Both I do not have a license

Is your license active Yes No Not Applicable

Your current employment status:  Employed Unemployed Self-Employed Student

Employment History (Company Name, Location, Length of Employment)

Have you ever been convicted of a crime?  Yes No

Have you worked for United Special Patrol before? Yes No

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